Are overweight asthmatics more difficult to control?

• Published in: Allergy (Copenhagen) Vol. 61; no. 1; pp. 79 - 84
• Main Authors: Saint‐Pierre, P., Bourdin, A., Chanez, P., Daures, J.‐P., Godard, P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Munksgaard International Publishers 01.01.2006; Blackwell; Wiley
• Subjects: Adrenal Cortex Hormones - therapeutic use; Adult; Allergic diseases; Anti-Asthmatic Agents - therapeutic use; Applications; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; asthma control; Biological and medical sciences; Body Mass Index; Comorbidity; Female; follow up; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Humans; Immunopathology; Life Sciences; Longitudinal Studies; Male; Markov Chains; Markov model; Medical sciences; Middle Aged; Obesity - diagnosis; Obesity - epidemiology; Probability; Prospective Studies; Respiratory Function Tests; Risk Assessment; Santé publique et épidémiologie; Severity of Illness Index; Statistics; Treatment Outcome; Immunopathology; Lung disease; Allergy; Respiratory disease; asthma control; Markov model; Asthma; Overweight; follow up; Body mass index; Immunology; Bronchus disease; Obstructive pulmonary disease
• ISSN: 0105-4538; 1398-9995
• DOI: 10.1111/j.1398-9995.2005.00953.x

The relationship between asthma and obesity appears to be quite complex. The aim of this study was to assess the effect of excess weight on asthma control evolution in a cohort of asthmatics. A prospective database was set up, which enrolled adult asthmatics with persistent (mild, moderate or severe) asthma. The control of asthma was defined as a binary variable, acceptable or unacceptable. In order to evaluate the effect of body mass index (BMI; <25 or ≥25), data were analysed using a continuous time homogeneous Markov model in which the forces ruling the transition between the two health states were estimated. The following confounding covariates were also evaluated in the model: severity of asthma, current treatment with oral corticosteroids (OCS) and history of OCS over the year preceding inclusion. About 406 asthmatics were included who made a total of 1639 consultations; the median length of follow up was 182 days. Using a univariate model, overweight patients had a lower risk of transiting from the unacceptable to the acceptable health state (RR = 0.45; P < 0.01). The effect of weight remained significant (RR = 0.53; P < 0.01) in the multivariate model including the other covariates. Moreover, transition probabilities stabilized more rapidly for patients with BMI < 25 (200 vs 300 days). In this study, we thus demonstrated that there is an association between excess weight and transition from unacceptable to acceptable control. Because control of asthma clearly drives asthma management, this finding has consequences for defining original new strategies for managing asthma in overweight patients.