Abdominal and General Adiposity and Level of Asthma Control in Adults with Uncontrolled Asthma

Lv, Nan; Xiao, Lan; Camargo, Carlos A.; Wilson, Sandra R.; Buist, A. Sonia; Strub, Peg; Nadeau, Kari; Ma, Jun

doi:10.1513/annalsats.201405-214oc

Cited by 37 publications

(24 citation statements)

References 48 publications

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“…Although our findings for general adiposity and symptoms extend those of prior studies [48–50] to U.S. Hispanics, we did not replicate a linear association between BMI and asthma symptoms found in non-Hispanic whites [49]. Further, attenuation of the association of abnormal waist circumference with FVC and FEV 1 , when adjusted for hs-CRP and HDL, suggest that systemic inflammation and metabolic dysregulation, intricately linked to truncal adiposity, drive its association with asthma burden.…”

Section: Discussionsupporting

confidence: 80%

Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults

Rastogi

Jung

Strizich

et al. 2017

Respiratory Medicine

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Rationale Obesity-related asthma is associated with higher disease burden than normal-weight asthma among Hispanics. Adiposity, metabolic dysregulation, and inflammation are all implicated in pathogenesis of obesity-related asthma, but their independent contributions are poorly understood. Objective To examine the independent contributions of body fat distribution, metabolic abnormalities and inflammation on asthma symptoms and pulmonary function among Hispanics. Methods Participants of the Hispanic Community Health Study/Study of Latinos with doctor-diagnosed asthma who completed an asthma symptom questionnaire and performed a valid spirometry were included in the analysis (n=1,126). Multivariate analysis was used to examine the independent association of general adiposity (assessed using body mass index), truncal adiposity (assessed by waist circumference), metabolic dysregulation (presence of insulin resistance and low HDL) and inflammation (high-sensitivity C-Reactive Protein≥3mg/L) with reported asthma symptoms or pulmonary function measures (FEV1, and FVC) while adjusting for demographic and clinical covariates. Results Of the 1,126 participants, 334 (29.5%) were overweight, and 648 (57.8%) were obese. FEV1 and FVC were lower in obese compared to normal-weight asthmatics. In analyses controlling for metabolic and adiposity factors, high hs-CRP (>7 mg/L) was associated with more symptoms (prevalence-ratio 1.27 (95%CI 1.05, 1.54), and lower FVC (β −138ml (95%CI −27ml, −249ml)) and FEV1 (β −155ml (95% CI −38ml, −272ml). Low HDL was also associated with lower FVC (β −111ml (−22ml, −201ml) and FEV1 (β −100ml (−12ml, −188ml)). Results were similar in men and women. Conclusions Our findings suggest that hs-CRP and low HDL, rather than general and truncal adiposity, are associated with asthma burden among overweight and obese Hispanic adults.

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Section: Discussionsupporting

confidence: 80%

Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults

Rastogi

Jung

Strizich

et al. 2017

Respiratory Medicine

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“…Obesity is associated with poorer asthma symptom control, asthma‐related quality of life and frequent exacerbations . Waist circumference and waist‐height ratio also predict worse symptoms, supporting a role for fat distribution …”

Section: To What Degree Do Comorbidities Contribute To Difficult Asthma?mentioning

confidence: 96%

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Tay

Hew

2017

Allergy

125

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The care of patients with difficult-to-control asthma ("difficult asthma") is challenging and costly. Despite high-intensity asthma treatment, these patients experience poor asthma control and face the greatest risk of asthma morbidity and mortality.Poor asthma control is often driven by severe asthma biology, which has appropriately been the focus of intense research and phenotype-driven therapies. However, it is increasingly apparent that extra-pulmonary comorbidities also contribute substantially to poor asthma control and a heightened disease burden. These comorbidities have been proposed as "treatable traits" in chronic airways disease, adding impetus to their evaluation and management in difficult asthma. In this review, eight major asthma-related comorbidities are discussed: rhinitis, chronic rhinosinusitis, gastroesophageal reflux, obstructive sleep apnoea, vocal cord dysfunction, obesity, dysfunctional breathing and anxiety/depression. We describe the prevalence, impact and treatment effects of these comorbidities in the difficult asthma population, emphasizing gaps in the current literature. We examine the associations between individual comorbidities and highlight the potential for comorbidity clusters to exert combined effects on asthma outcomes. We conclude by outlining a pragmatic clinical approach to assess comorbidities in difficult asthma.

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“…It is well established that both generic and respiratory-specific HRQL are poor among patients with asthma and COPD [15, 16, 19, 32]. However, the interrelationships among OSA, respiratory comorbidity, sleepiness, and respiratory-specific HRQL are less clear-cut.…”

Section: Discussionmentioning

confidence: 99%

Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea

Vinnikov

Blanc

Alilin

et al. 2017

Health Qual Life Outcomes

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BackgroundIn those with symptoms indicative of obstructive sleep apnea (OSA), respiratory-specific health-related quality of life (HRQL) may be an important patient-centered outcome. The aim of this study was to assess the associations between sleepiness, fatigue, and impaired general and respiratory-specific HRQL among persons with suspected OSA.MethodsWe evaluated military veterans consecutively referred for suspected OSA with sleep studies yielding apnea-hypopnea index (AHI) values. They also completed the sleepiness (Epworth Sleepiness Scale [ESS]), and fatigue (Fatigue Severity Scale [FSS]) questionnaires, as well as two HRQL instruments (the generic Short-Form SF-12v2 yielding the Physical Component Scale [PCS] and the respiratory-specific Airways Questionnaire [AQ]-20R). Multiple linear regression tested the associations between ESS and FSS (standardized as Z scores for scaling comparability) with AQ-20R, accounting for AHI, SF-12v2-PCS and comorbid respiratory conditions other than OSA.ResultsWe studied 1578 veterans (median age 61.1 [IQR 16.8] years; 93.9% males). Of these, 823 (52%) met AHI criteria for moderate to severe OSA (AHI ≥15/h). The majority reported excessive daytime sleepiness (53%; median ESS 11 [IQR 9]) or fatigue (61%; median FSS 42 [IQR 23]). The median AQ-20R was 4 [IQR 1–8]. Controlling for AHI, SF-12v2-PCS, respiratory co-morbid conditions, body mass index, and demographics, both ESS and FSS were significantly associated with poorer AQ-20R: for each; ESS, 1.6 points (95% CI 1.4–1.9), and for FSS, 2.5 points (95% CI, 2.3–2.7).ConclusionsGreater daytime sleepiness and fatigue are associated with poorer respiratory-specific HRQL, over and above the effects of OSA, respiratory comorbidity, and generic physical HRQL.

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Abdominal and General Adiposity and Level of Asthma Control in Adults with Uncontrolled Asthma

Cited by 37 publications

References 48 publications

Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults

Association of systemic inflammation, adiposity, and metabolic dysregulation with asthma burden among Hispanic adults

Comorbid “treatable traits” in difficult asthma: Current evidence and clinical evaluation

Fatigue and sleepiness determine respiratory quality of life among veterans evaluated for sleep apnea

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