Characterization of Self-reported Asthma in Morbidly Obese Women
Presented By: Alton R. Johnson Jr.
Outline Asthma
Pathophysiology, epidemiology, & diagnosis
Obesity Definition, trends, morbidity
Obesity & asthma association Supporting evidence
Summer Research Project
Pathophysiology Asthma
Inflammation
Airway Hyperresponsiveness
Airway Obstruction
Clinical symptoms
Epidemology of asthma One of the most common chronic
respiratory diseases affects approx. 7% of population (22
million) (CDC, 2010)▪ 27% are children (>6 million) (CDC, 2010)
Associated with significant morbidity▪ African American children have a 250%
higher hospitalization rate and a 500% higher death rate (CDC, 2010)
Asthma: Prevalence Prevalence = (# of people with the disease) / (# of people
at risk for disease + # of people with the disease) Increasing prevalence over past 20 years (NAEPP, 2010) Significant disparity.
Obesity
Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
20081990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
Obesity and Asthma
Cross-sectional studies Increased prevalence of asthma in obese
patients Obesity associated with worst asthma control
and increased morbidity (severe symptoms)
Longitudinal studies Asthma risk increases by 50 % in overweight
and obese people AHR is associated with increased BMI
Obesity associated with increased risk of asthma
Beuther and Sutherland 2007
Obesity and Asthma Possible explanations:
Causal link▪ Obesity leads to increased risk of asthma▪ Inflammatory pathway▪Mechanical pathway
Coincidental▪ Epiphenomenon▪ Shared risk factors (i.e. genetic, environmental)
Diagnostic bias
Effects of obesity on asthma control/severity
Controversial findings Some studies showing worst asthma
symptoms in obese patients (Schacter et.al. 2001)
Others have not (Clerisme-Beaty et.al. 2009) Limited by use of self-report or
questionnaire to diagnose asthma
Obesity is associated with changes in lung volumes which may mimic asthma.
It is unclear whether the asthma phenotype is different in obese patients
Project Importance
To examine differences in pulmonary function profile, respiratory symptoms, and quality of life in morbidly obese women based on self-reported asthma.
Objective
53 participants were recruited to participate in the study. 11 were excluded based on gender, leaving 42 women in the final analysis.
Recruitment
Results
Baseline Demographics
General Health Survey Results
Respiratory Questionnaire
Pulmonary Function Profile
Air Hyperresponsiveness
24 participants (6 asthmatics, 18 non-asthmatics) 60% asthmatics had positive AHR
40% non-asthmatics had positive AHR
Conclusions Both Groups:
Decreased quality of life Increased reports of respiratory symptoms Trend for lower FEV1/FVC
Asthmatics: Significantly more respiratory complaints Lower quality of life
Symptoms rather than objective differences in respiratory function may guide the diagnosis of asthma in this population
Limitation
It is unclear whether these findings apply to men or patients with less severe obesity.
Acknowledgements Emmanuelle Clerisme-Beaty, MD MHS Mercedes Proctor, BA Andrew Bilderback, MS Cynthia Rand, PhD Flona Redway, PhD Denise Guise
Funding: NIH/NHLBI grant R25 HL084762, Johns Hopkins
University NIH grant K12RR01767, Johns Hopkins University NIH-NIGMS RISE Grant, R25 GM059244-09, Barry
University
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