Reviews and feature article
The relationship between obesity and asthma severity and control in adults

https://doi.org/10.1016/j.jaci.2008.06.024Get rights and content

Background

The association of obesity with asthma outcomes is not well understood.

Objective

The objective of this study was to examine the association of obesity, as represented by a body mass index (BMI) of greater than 30 kg/m2, with quality-of-life scores, asthma control problems, and asthma-related hospitalizations.

Methods

The study followed a cross-sectional design. Questionnaires were completed at home by a random sample of 1113 members of a large integrated health care organization who were 35 years of age or older with health care use suggestive of active asthma. Outcomes included the mini-Asthma Quality of Life Questionnaire, the Asthma Therapy Assessment Questionnaire, and self-reported asthma-related hospitalization. Several other factors known to influence asthma outcomes also were collected: demographics, smoking status, oral corticosteroid use in the past month, evidence of gastroesophageal reflux disease, and inhaled corticosteroid use in the past month. Multiple logistic regression models were used to measure the association of BMI status with outcomes.

Results

Even after adjusting for demographics, smoking status, oral corticosteroid use, evidence of gastroesophageal reflux disease, and inhaled corticosteroid use, obese adults were more likely than those with normal BMIs (<25 kg/m2) to report poor asthma-specific quality of life (odds ratio [OR], 2.8; 95% CI, 1.6-4.9), poor asthma control (OR, 2.7; 95% CI, 1.7-4.3), and a history of asthma-related hospitalizations (OR, 4.6; 95% CI, 1.4-14.4).

Conclusions

Our findings suggest that obesity is associated with worse asthma outcomes, especially an increased risk of asthma-related hospitalizations.

Section snippets

Study subjects

Study participants were members of the Colorado and Northwest regions of Kaiser Permanente, a large managed care organization centered in Denver, Colorado, and Portland, Oregon, respectively. Health plan members were eligible for the study if they were at least 35 years of age and had, in the 2-year period preceding the survey, at least 1 documented asthma-related medical encounter and at least a 6-month supply of asthma medication dispensed. These criteria were used to identify a population

Sample characteristics

As shown in Table I, study participants were well educated (nearly 50% with a college degree or higher), primarily of white race/ethnicity (86%), and equally split between men and women. In addition, nearly 40% were obese, approximately half were current or former smokers, and nearly 40% reported a history of GERD. The mean age of the cohort was 56.8 years, and 73% were younger than 65 years.

Approximately 14% of the cohort reported any use of oral corticosteroids in the past month, whereas 60%

Discussion

This study found that obese individuals with persistent asthma were significantly more likely than those with normal BMIs to report worse asthma-related quality of life, worse asthma control, and more asthma-related hospitalizations. We also found that being overweight (BMI, 25.0-30 kg/m2) was not associated with adverse study outcomes. The results suggest that being overweight might not be associated with more severe or difficult-to-control asthma. Our finding regarding obesity status and

References (28)

  • C.A. Camargo et al.

    Prospective study of body mass index, weight change, and risk of adult-onset asthma in women

    Arch Intern Med

    (1999)
  • A. Macgregor et al.

    Effect of surgically induced weight loss on asthma in the morbidly obese

    Obes Surg

    (1993)
  • J.B. Dixon et al.

    Marked improvement in asthma after Lap-Band surgery for morbid obesity

    Obes Surg

    (1999)
  • B. Stenius-Aarniala et al.

    Immediate and long term effects of weight reduction in obese people with asthma: randomized controlled study

    BMJ

    (2000)
  • Cited by (269)

    • Systemic Inflammation in Asthma: What Are the Risks and Impacts Outside the Airway?

      2024, Journal of Allergy and Clinical Immunology: In Practice
    • Obesity and asthma: A focused review

      2022, Respiratory Medicine
    • An Online Weight Loss Intervention for People With Obesity and Poorly Controlled Asthma

      2022, Journal of Allergy and Clinical Immunology: In Practice
    View all citing articles on Scopus

    Disclosure of potential conflict of interest: M. Schatz has consulting arrangements with GlaxoSmithKline and has received research support from GlaxoSmithKline and Merck. C. A. Camargo has consulting arrangements with AstraZeneca, Novartis, and Critical Therapeutics; is on the advisory board for Dey, Genentech, GlaxoSmithKline, Merck, Novartis, and Schering-Plough; is on the speakers' bureau for AstraZeneca, GlaxoSmithKline, and Merck; and has received research support from the National Institutes of Health, Research Foundations, AstraZeneca, Critical Therapeutics, GlaxoSmithKline, Merck, Novartis, and Respironics. The rest of the authors have declared that they have no conflict of interest.

    View full text