351
|
Gagnon P, Guenette JA, Langer D, Laviolette L, Mainguy V, Maltais F, Ribeiro F, Saey D. Pathogenesis of hyperinflation in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2014; 9:187-201. [PMID: 24600216 PMCID: PMC3933347 DOI: 10.2147/copd.s38934] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Chronic obstructive pulmonary disease (COPD) is a preventable and treatable lung disease characterized by airflow limitation that is not fully reversible. In a significant proportion of patients with COPD, reduced lung elastic recoil combined with expiratory flow limitation leads to lung hyperinflation during the course of the disease. Development of hyperinflation during the course of COPD is insidious. Dynamic hyperinflation is highly prevalent in the advanced stages of COPD, and new evidence suggests that it also occurs in many patients with mild disease, independently of the presence of resting hyperinflation. Hyperinflation is clinically relevant for patients with COPD mainly because it contributes to dyspnea, exercise intolerance, skeletal muscle limitations, morbidity, and reduced physical activity levels associated with the disease. Various pharmacological and nonpharmacological interventions have been shown to reduce hyperinflation and delay the onset of ventilatory limitation in patients with COPD. The aim of this review is to address the more recent literature regarding the pathogenesis, assessment, and management of both static and dynamic lung hyperinflation in patients with COPD. We also address the influence of biological sex and obesity and new developments in our understanding of hyperinflation in patients with mild COPD and its evolution during progression of the disease.
Collapse
Affiliation(s)
- Philippe Gagnon
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Jordan A Guenette
- Centre for Heart Lung Innovation, University of British Columbia, St Paul's Hospital, Vancouver, BC, Canada ; Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Daniel Langer
- Department of Kinesiology and Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Louis Laviolette
- Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | | | - François Maltais
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Fernanda Ribeiro
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| | - Didier Saey
- Faculté de Médecine, Université Laval, Québec, QC, Canada ; Centre de Recherche, Institut Universitaire de Cardiologie et de Pneumologie de Québec, Université Laval, Québec, QC, Canada
| |
Collapse
|
352
|
Oppenheimer BW, Berger KI, Segal LN, Stabile A, Coles KD, Parikh M, Goldring RM. Airway dysfunction in obesity: response to voluntary restoration of end expiratory lung volume. PLoS One 2014; 9:e88015. [PMID: 24505355 PMCID: PMC3913722 DOI: 10.1371/journal.pone.0088015] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2013] [Accepted: 01/02/2014] [Indexed: 11/18/2022] Open
Abstract
Introduction Abnormality in distal lung function may occur in obesity due to reduction in resting lung volume; however, airway inflammation, vascular congestion and/or concomitant intrinsic airway disease may also be present. The goal of this study is to 1) describe the phenotype of lung function in obese subjects utilizing spirometry, plethysmography and oscillometry; and 2) evaluate residual abnormality when the effect of mass loading is removed by voluntary elevation of end expiratory lung volume (EELV) to predicted FRC. Methods 100 non-smoking obese subjects without cardio-pulmonary disease and with normal airflow on spirometry underwent impulse oscillometry (IOS) at baseline and at the elevated EELV. Results FRC and ERV were reduced (44±22, 62±14% predicted) with normal RV/TLC (29±9%). IOS demonstrated elevated resistance at 20 Hz (R20, 4.65±1.07 cmH2O/L/s); however, specific conductance was normal (0.14±0.04). Resistance at 5–20 Hz (R5−20, 1.86±1.11 cmH2O/L/s) and reactance at 5 Hz (X5, −2.70±1.44 cmH2O/L/s) were abnormal. During elevation of EELV, IOS abnormalities reversed to or towards normal. Residual abnormality in R5−20 was observed in some subjects despite elevation of EELV (1.16±0.8 cmH2O/L/s). R5−20 responded to bronchodilator at baseline but not during elevation of EELV. Conclusions This study describes the phenotype of lung dysfunction in obesity as reduction in FRC with airway narrowing, distal respiratory dysfunction and bronchodilator responsiveness. When R5−20 normalized during voluntary inflation, mass loading was considered the predominant mechanism. In contrast, when residual abnormality in R5−20 was demonstrable despite return of EELV to predicted FRC, mechanisms for airway dysfunction in addition to mass loading could be invoked.
Collapse
Affiliation(s)
- Beno W. Oppenheimer
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
- * E-mail:
| | - Kenneth I. Berger
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
| | - Leopoldo N. Segal
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
| | - Alexandra Stabile
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
| | - Katherine D. Coles
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
| | - Manish Parikh
- Bellevue Hospital Bariatric Center, Department of Surgery, New York University School of Medicine, New York, New York, United States of America
| | - Roberta M. Goldring
- André Cournand Pulmonary Physiology Laboratory, Division of Pulmonary, Critical Care and Sleep, Department of Medicine, Bellevue Hospital/New York University School of Medicine, New York, New York, United States of America
| |
Collapse
|
353
|
Banerjee J, Roy A, Singhamahapatra A, Dey PK, Ghosal A, Das A. Association of Body Mass Index (BMI) with Lung Function Parameters in Non-asthmatics Identified by Spirometric Protocols. J Clin Diagn Res 2014; 8:12-4. [PMID: 24701468 DOI: 10.7860/jcdr/2014/7306.3993] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Accepted: 12/24/2013] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Association between obesity and asthma has been reported widely, with disparity between males and females. Epidemiological data which indicate that obesity precedes development of asthma and increases the prevalence and incidence of asthma, raises the possibility of a causal association. AIM To find out the association, including gender differences, between Body Mass Index (BMI) and lung functions in non-asthmatics identified by spirometric protocols. METHODS A retrospective analysis was conducted of the spirometry results obtained between October 2012 and March 2013 for six months. Participants were referred by a variety of medical specialties to the pulmonary function laboratory in Physiology department, R.G. Kar Medical College, Kolkata, India of the 590 test results recorded in the study database 424 non-asthmatic subjects were reviewed. RESULTS Significant differences in the spirometric parameters, measured as a percentage of predicted were evident between male and female. Among obese subjects significant correlation is found between BMI and pulmonary function values, FEV1(r = -0.531, p=0.009); FEF25-75% (r= -0.653, p=0.001); FEV1/FVC (r= - 0.603, p=0.002). Significant association was found between BMI and lung function in obese female but not in obese male. CONCLUSION Association was found between indices of spirometry and BMI in non-asthmatic obese group along with a gender disparity.
Collapse
Affiliation(s)
- Joyashree Banerjee
- Assistant Professor, Department of Physiology, R.G. Kar Medical College , Kolkata, India
| | - Anindya Roy
- Assistant Professor, Department of Physiology, R.G. Kar Medical College , Kolkata, India
| | | | - Pranab Kumar Dey
- Clinical Tutor, Department of Paediatrics, Medical College , Kolkata, India
| | - Achyut Ghosal
- Professor, Department of Physiology, R.G. Kar Medical College , Kolkata, India
| | - Anubrata Das
- Junior Resident, Department of Physiology, R.G. Kar Medical College , Kolkata, India
| |
Collapse
|
354
|
Lee CK, Tefera E, Colice G. The effect of obesity on outcomes in mechanically ventilated patients in a medical intensive care unit. ACTA ACUST UNITED AC 2014; 87:219-26. [PMID: 24457313 DOI: 10.1159/000357317] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2013] [Accepted: 11/05/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND The effect of obesity on outcomes in critically ill patients requiring invasive mechanical ventilation in a medical intensive care unit (ICU) is uncertain. OBJECTIVES This study was intended to further explore the relationship between outcomes and obesity in patients admitted to a medical ICU who required invasive mechanical ventilation. METHODS All adult patients admitted to the medical ICU at Washington Hospital Center requiring intubation and invasive mechanical ventilation for at least 24 h between January 1 and December 31, 2009, were retrospectively studied. Patients were categorized as nonobese (BMI <30) and obese (BMI ≥30). The primary outcome measure was 30-day mortality following intubation. Secondary outcomes included ICU length of stay (LOS), hospital LOS and duration of mechanical ventilation. RESULTS There were 504 eligible patients: 306 nonobese and 198 (39%) obese. Obese patients had significantly higher rates of diabetes (43 vs. 30%, p = 0.004), hyperlipidemia (32 vs. 24%, p = 0.04), asthma (16 vs. 8%, p = 0.004) and obstructive sleep apnea requiring continuous positive airway pressure treatment (12 vs. 1%, p < 0.001). Nonobese patients had a significantly higher rate of HIV infection (10 vs. 5%, p = 0.05) and malignancy (21 vs. 13%, p = 0.03). There were no significant differences in mortality up to 30 days following intubation and secondary outcomes between obese and nonobese patients. Multivariate analysis using logistic regression showed no significant relationship between mortality rate at 30 days following intubation and obesity. Outcomes were similar for the black obese (n = 153) and nonobese (n = 228) patients and the obese (n = 85) and very obese (n = 113) patients. CONCLUSIONS Obesity did not influence outcomes in critically ill patients requiring invasive mechanical ventilation in a medical ICU. Black obese patients had similar outcomes to black nonobese patients, and very obese patients also had similar outcomes to obese patients.
Collapse
|
355
|
Lean mass, not fat mass, is associated with lung function in male and female children with asthma. Pediatr Res 2014; 75:93-8. [PMID: 24129552 DOI: 10.1038/pr.2013.181] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 06/11/2013] [Indexed: 01/09/2023]
Abstract
BACKGROUND Whether body composition is associated with lung function in asthmatic children has not been investigated. This study aimed to primarily investigate whether BMI z-score and body composition were associated with respiratory function in asthmatic children. METHODS In a cross-sectional study, male (n = 27; mean age: 11.9 y (SD: 2.3)) and female (n = 21; mean age: 13.6 y (SD: 2.2)) asthmatic children underwent clinical assessment. RESULTS BMI z-score was associated with forced expiratory volume in 1 s (FEV1; r = 0.458), forced vital capacity (FVC; r = 0.477), and total lung capacity (TLC; r = 0.451) in males only (P < 0.05). Total lean mass was associated with FEV1 (r = 0.655), FVC (r = 0.562), and TLC (r = 0.635) in males, as was thoracic lean mass (FEV1 (r = 0.573), FVC (r = 0.526), and TLC (r = 0.497); P < 0.05). TLC was associated with total (r = 0.522) and thoracic (r = 0.532) lean mass in females (P < 0.05). Fat mass was not associated with lung function in this group. CONCLUSION Lean mass, not fat mass, is associated with lung function in children with asthma. The positive association between BMI z-score and respiratory function in male children is driven by lean mass. Although body weight can be easily monitored in the clinical setting, body composition can provide important information. Future research exploring lean mass and lung function associations could inform future interventions.
Collapse
|
356
|
Martins IJ. Induction of NAFLD with Increased Risk of Obesity and Chronic Diseases in Developed Countries. ACTA ACUST UNITED AC 2014. [DOI: 10.4236/ojemd.2014.44011] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
357
|
Associação entre a mecânica respiratória e função autonómica na obesidade mórbida. REVISTA PORTUGUESA DE PNEUMOLOGIA 2014; 20:31-5. [DOI: 10.1016/j.rppneu.2013.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 06/20/2013] [Accepted: 06/22/2013] [Indexed: 11/18/2022] Open
|
358
|
Manens J, Ricci R, Damoiseaux C, Gault S, Contiero B, Diez M, Clercx C. Effect of body weight loss on cardiopulmonary function assessed by 6-minute walk test and arterial blood gas analysis in obese dogs. J Vet Intern Med 2013; 28:371-8. [PMID: 24351032 PMCID: PMC4858022 DOI: 10.1111/jvim.12260] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2013] [Revised: 10/05/2013] [Accepted: 10/24/2013] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Few studies show the detrimental effect of canine obesity on cardiopulmonary function (CPF). The 6-Minute Walk Test (6MWT) is a noninvasive exercise test easy to perform in clinical settings. OBJECTIVE The aim of this study was to investigate the effect of obesity and body weight loss (BWL) on CPF assessed by the 6MWT and arterial blood gas analysis. ANIMALS Six experimental Beagles and 9 privately owned obese dogs were enrolled in a diet-induced BWL program. METHODS Arterial blood gas analysis and 6MWT were repeated in obese subjects (BCS 8-9/9), in the middle of BWL (overweight, BCS 6-7/9), and in lean dogs (BCS 5/9). Heart rate (HRp) and oxygen saturation (SpO2 ) were measured by pulse oximetry before the 6MWT, at midtest, and during a 5-minute recovery period. RESULTS Twelve dogs completed the BWL program (initial BW, 27.3 ± 2.9 kg; final BW, 20.85 ± 2.9, lsmeans ± SE, P ≤ .001). BWL caused a significant increase in 6MWT walked distance (WD; obese: 509 ± 35 m; overweight: 575 ± 36 m; lean: 589 ± 36 m; P ≤ .05). Resting arterial blood gas results were not influenced by BWL. Including all time points, obese dogs showed higher HRp and lower SpO2 compared to overweight and lean dogs. SpO2 at the end of the walk was significantly lower in obese dogs. CONCLUSION AND CLINICAL IMPORTANCE Obesity negatively affects 6MWT performances in dogs. The 6MWT may be used to demonstrate the efficacy of BWL to improve CPF and quality of life in obese dogs. Although BWL induced significant improvement of cardiopulmonary parameters before ideal BW, WD improved until the end of the BWL program.
Collapse
Affiliation(s)
- J Manens
- Department for Clinical Sciences, Faculty of Veterinary Medicine, University of Liège, Belgium
| | | | | | | | | | | | | |
Collapse
|
359
|
Mauri T, Bellani G, Salerno D, Mantegazza F, Pesenti A. Regional Distribution of Air Trapping in Chronic Obstructive Pulmonary Disease. Am J Respir Crit Care Med 2013; 188:1466-7. [DOI: 10.1164/rccm.201303-0463im] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
360
|
Spruit MA, Singh SJ, Garvey C, ZuWallack R, Nici L, Rochester C, Hill K, Holland AE, Lareau SC, Man WDC, Pitta F, Sewell L, Raskin J, Bourbeau J, Crouch R, Franssen FME, Casaburi R, Vercoulen JH, Vogiatzis I, Gosselink R, Clini EM, Effing TW, Maltais F, van der Palen J, Troosters T, Janssen DJA, Collins E, Garcia-Aymerich J, Brooks D, Fahy BF, Puhan MA, Hoogendoorn M, Garrod R, Schols AMWJ, Carlin B, Benzo R, Meek P, Morgan M, Rutten-van Mölken MPMH, Ries AL, Make B, Goldstein RS, Dowson CA, Brozek JL, Donner CF, Wouters EFM. An official American Thoracic Society/European Respiratory Society statement: key concepts and advances in pulmonary rehabilitation. Am J Respir Crit Care Med 2013; 188:e13-64. [PMID: 24127811 DOI: 10.1164/rccm.201309-1634st] [Citation(s) in RCA: 2119] [Impact Index Per Article: 192.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Pulmonary rehabilitation is recognized as a core component of the management of individuals with chronic respiratory disease. Since the 2006 American Thoracic Society (ATS)/European Respiratory Society (ERS) Statement on Pulmonary Rehabilitation, there has been considerable growth in our knowledge of its efficacy and scope. PURPOSE The purpose of this Statement is to update the 2006 document, including a new definition of pulmonary rehabilitation and highlighting key concepts and major advances in the field. METHODS A multidisciplinary committee of experts representing the ATS Pulmonary Rehabilitation Assembly and the ERS Scientific Group 01.02, "Rehabilitation and Chronic Care," determined the overall scope of this update through group consensus. Focused literature reviews in key topic areas were conducted by committee members with relevant clinical and scientific expertise. The final content of this Statement was agreed on by all members. RESULTS An updated definition of pulmonary rehabilitation is proposed. New data are presented on the science and application of pulmonary rehabilitation, including its effectiveness in acutely ill individuals with chronic obstructive pulmonary disease, and in individuals with other chronic respiratory diseases. The important role of pulmonary rehabilitation in chronic disease management is highlighted. In addition, the role of health behavior change in optimizing and maintaining benefits is discussed. CONCLUSIONS The considerable growth in the science and application of pulmonary rehabilitation since 2006 adds further support for its efficacy in a wide range of individuals with chronic respiratory disease.
Collapse
|
361
|
Raveendran R, Chung F. Perioperative Management of the Morbidly Obese. Anesth Analg 2013. [DOI: 10.1213/ane.0b013e318295d49b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
|
362
|
Mosing M, German A, Holden S, MacFarlane P, Biourge V, Morris P, Iff I. Oxygenation and ventilation characteristics in obese sedated dogs before and after weight loss: A clinical trial. Vet J 2013; 198:367-71. [PMID: 24048017 DOI: 10.1016/j.tvjl.2013.08.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Revised: 06/26/2013] [Accepted: 08/06/2013] [Indexed: 10/26/2022]
|
363
|
Abstract
Chronic pulmonary disease is common among the surgical population and the importance of a thorough and detailed preoperative assessment is monumental for minimizing morbidity and mortality and reducing the risk of perioperative pulmonary complications. These comorbidities contribute to pulmonary postoperative complications, including atelectasis, pneumonia, and respiratory failure, and can predict long-term mortality. The important aspects of the preoperative assessment for patients with chronic pulmonary disease, and the value of preoperative testing and smoking cessation, are discussed. Specifically discussed are preoperative pulmonary assessment and management of patients with chronic obstructive pulmonary disease, asthma, restrictive lung disease, obstructive sleep apnea, and obesity.
Collapse
Affiliation(s)
- Caron M Hong
- Department of Anesthesiology, University of Maryland School of Medicine, 22 South Greene Street, S11C0, Baltimore, MD 21201, USA.
| | | |
Collapse
|
364
|
Abstract
Obesity currently affects about one-third of the U.S. population, while another one-third is overweight. The importance of obesity for certain conditions such as heart disease and type 2 diabetes is well appreciated. The effects of obesity on the respiratory system have received less attention and are the subject of this article. Obesity alters the static mechanical properties of the respiratory system leading to a reduction in the functional residual capacity (FRC) and the expiratory reserve volume (ERV). There is substantial variability in the effects of obesity on FRC and ERV, at least some of which is related to the location rather than the total mass of adipose tissue. Obesity also results in airflow obstruction, which is only partially attributable to breathing at low lung volume, and can also promote airway hyperresponsiveness and asthma. Hypoxemia is common is obesity and correlates well with FRC, as well as with measures of abdominal obesity. However, obese subjects are usually eucapnic, indicating that hypoventilation is not a common cause of their hypoxemia. Instead, hypoxemia results from ventilation-perfusion mismatch caused by closure of dependent airways at FRC. Many obese subjects complain of dyspnea either at rest or during exertion, and the dyspnea score also correlates with reductions in FRC and ERV. Weight reduction should be encouraged in any symptomatic obese individual, since virtually all of the respiratory complications of obesity improve with even moderate weight loss.
Collapse
|
365
|
Acoustic, perceptual and aerodynamic voice evaluation in an obese population. The Journal of Laryngology & Otology 2013; 127:987-90. [DOI: 10.1017/s0022215113001916] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractObjective:To investigate perceptual, acoustic and aerodynamic voice parameters in obese individuals.Methods:Twenty obese and 20 normal-weight volunteers underwent voice evaluation by laryngoscopy, acoustic analysis, aerodynamic measurement and perceptual analysis (using the grade-roughness-breathiness-asthenia-strain (‘GRBAS') scale and the Voice Handicap Index 10 scale). Data from both subject groups were compared.Results:No difference was found in acoustic analysis parameters between the two groups (p > 0.05). Maximum phonation time in the obese group (mean ± standard deviation, 19.6 ± 4.9 seconds) was significantly shorter than in controls (26.4 ± 4.1 seconds) (p < 0.001), although the s/z ratio was very similar between the two groups. In the obese and control groups, the mean ± standard deviation grade-roughness-breathiness-asthenia-strain scores were 1 ± 1.3 and 0.2 ± 0.6 (p = 0.002) and the mean ± standard deviation Voice Handicap Index 10 scores were 0.5 ± 1.2 and 1.2 ± 1.7 (p = 0.27), respectively.Conclusion:Obese individuals had poorer vocal quality as judged by the grade-roughness-breathiness-asthenia-strain scale, and reduced maximum phonation time. However, there was no change in voice quality as assessed by acoustic analysis and Vocal Handicap Index 10 score, compared with controls.
Collapse
|
366
|
Kumar G, Majumdar T, Jacobs ER, Danesh V, Dagar G, Deshmukh A, Taneja A, Nanchal R. Outcomes of morbidly obese patients receiving invasive mechanical ventilation: a nationwide analysis. Chest 2013; 144:48-54. [PMID: 23349057 DOI: 10.1378/chest.12-2310] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Critically ill, morbidly obese patients (BMI≥40 kg/m2) are at high risk of respiratory failure requiring invasive mechanical ventilation (IMV). It is not clear if outcomes of critically ill, obese patients are affected by obesity. Due to limited cardiopulmonary reserve, they may have poor outcomes. However, literature to this effect is limited and conflicted. METHODS We used the Nationwide Inpatient Sample from 2004 to 2008 to examine the outcomes of morbidly obese people receiving IMV and compared them to nonobese people. We identified hospitalizations requiring IMV and morbid obesity using International Classification of Diseases, 9th Revision, Clinical Modification codes. Primary outcomes studied were inhospital mortality, rates of prolonged mechanical ventilation (≥96 h), and tracheostomy. Multivariable logistic regression was used to adjust for potential confounding variables. We also examined outcomes stratified by number of organs failing. RESULTS Of all hospitalized, morbidly obese people, 2.9% underwent IMV. Mean age, comorbidity score, and severity of illness were lower in morbidly obese people. The adjusted mortality was not significantly different in morbidly obese people (OR 0.89; 95% CI, 0.74-1.06). When stratified by severity of disease, there was a stepwise increase in risk for mortality among morbidly obese people relative to nonobese people (range: OR, 0.77; 95% CI, 0.58-1.01 for only respiratory failure, to OR, 4.14; 95% CI, 1.11-15.3 for four or more organs failing). Rates of prolonged mechanical ventilation were similar, but rate of tracheostomy (OR 2.19; 95% CI, 1.77-2.69) was significantly higher in patients who were morbidly obese. CONCLUSIONS Morbidly obese people undergoing IMV have a similar risk for death as nonobese people if only respiratory failure is present. When more organs fail, morbidly obese people have increased risk for mortality compared with nonobese people.
Collapse
Affiliation(s)
- Gagan Kumar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Tilottama Majumdar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Elizabeth R Jacobs
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Clement J. Zablocki VA Medical Center, Milwaukee, WI
| | - Valerie Danesh
- Division of Critical Care Medicine, Orlando Regional Medical Center, Orlando, FL
| | - Gaurav Dagar
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Abhishek Deshmukh
- Division of Cardiology, University of Arkansas for Medical Sciences, Little Rock, AR
| | - Amit Taneja
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI
| | - Rahul Nanchal
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, WI.
| | | |
Collapse
|
367
|
Lang JE, Holbrook JT, Wise RA, Dixon AE, Teague WG, Wei CY, Irvin CG, Shade D, Lima JJ. Obesity in children with poorly controlled asthma: Sex differences. Pediatr Pulmonol 2013; 48:847-56. [PMID: 23143849 PMCID: PMC3578966 DOI: 10.1002/ppul.22707] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/22/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obesity increases asthma risk, and may alter asthma severity. In adults, sex appears to modify the effect of obesity on asthma. Among children, the effect of sex on the relationship between obesity and asthma severity remains less clear, particularly when considering race. OBJECTIVE To determine how obesity affects disease characteristics in a diverse cohort of children with poorly controlled asthma, and if obesity effects are altered by sex. DESIGN We analyzed 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month trial assessing lansoprazole for asthma control. In this secondary analysis, we determined associations between obesity and symptom severity, spirometry, exacerbation risk, airway biomarkers, bronchial reactivity, and airflow perception. We used both a multivariate linear regression and longitudinal mixed-effect model to determine if obesity interacted with sex to affect asthma severity. RESULTS Regardless of sex, BMI >95th percentile did not affect asthma control, exacerbation risk or airway biomarkers. Sex changed the effect of obesity on lung function (sex × obesity FEV1%, interaction P-value < 0.01, sex × obesity FEV1/FVC, interaction P-value = 0.03). Obese males had significantly worse airflow obstruction compared to non-obese males, while in females there was no obesity effect on airflow obstruction. In females, obesity was associated with significantly greater FEV1 and FVC, and a trend toward reduced airway reactivity. CONCLUSIONS Obesity did not affect asthma control, airway markers or disease stability; however obesity did affect lung function in a sex-dependent manner. In males, obesity associated with reduced FEV1/FVC, and in females, obesity associated with substantially improved lung function.
Collapse
Affiliation(s)
- Jason E Lang
- Division of Pulmonology, Allergy & Immunology, Nemours Children's Clinic, Jacksonville, Florida, USA.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
368
|
Potera C. Respiratory disparity? Obese people may not benefit from improved air quality. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:A283. [PMID: 24004901 PMCID: PMC3764085 DOI: 10.1289/ehp.121-a283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
|
369
|
Schikowski T, Schaffner E, Meier F, Phuleria HC, Vierkötter A, Schindler C, Kriemler S, Zemp E, Krämer U, Bridevaux PO, Rochat T, Schwartz J, Künzli N, Probst-Hensch N. Improved air quality and attenuated lung function decline: modification by obesity in the SAPALDIA cohort. ENVIRONMENTAL HEALTH PERSPECTIVES 2013; 121:1034-9. [PMID: 23820868 PMCID: PMC3764076 DOI: 10.1289/ehp.1206145] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Accepted: 06/27/2013] [Indexed: 05/03/2023]
Abstract
BACKGROUND Air pollution and obesity are hypothesized to contribute to accelerated decline in lung function with age through their inflammatory properties. OBJECTIVE We investigated whether the previously reported association between improved air quality and lung health in the population-based SAPALDIA cohort is modified by obesity. METHODS We used adjusted mixed-model analyses to estimate the association of average body mass index (BMI) and changes in particulate matter with aerodynamic diameter ≤ 10 µm (PM10; ΔPM10) with lung function decline over a 10-year follow-up period. RESULTS Lung function data and complete information were available for 4,664 participants. Age-related declines in lung function among participants with high average BMI were more rapid for FVC (forced vital capacity), but slower for FEV1/FVC (forced expiratory volume in 1 sec/FVC) and FEF25-75 (forced expiratory flow at 25-75%) than declines among those with low or normal average BMI. Improved air quality was associated with attenuated reductions in FEV1/FVC, FEF25-75, and FEF25-75/FVC over time among low- and normal-BMI participants, but not overweight or obese participants. The attenuation was most pronounced for ΔFEF25-75/FVC (30% and 22% attenuation in association with a 10-μg/m3 decrease in PM10 among low- and normal-weight participants, respectively.) CONCLUSION Our results point to the importance of considering health effects of air pollution exposure and obesity in parallel. Further research must address the mechanisms underlying the observed interaction.
Collapse
|
370
|
Distal airway impairment in obese normoreactive women. BIOMED RESEARCH INTERNATIONAL 2013; 2013:707856. [PMID: 24066295 PMCID: PMC3771240 DOI: 10.1155/2013/707856] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2013] [Revised: 07/09/2013] [Accepted: 07/23/2013] [Indexed: 11/20/2022]
Abstract
Background. Asthma-like symptoms are frequent in overweight and obesity, but the mechanism is unclear when airway hyperresponsiveness (AHR) is lacking. In this study, we focused on obese women with a clinical suspicion of asthma but negative methacholine challenge and tested distal airway hyperreactivity, explored by Forced Vital Capacity dose-response slope (FVC DRS). Objective. To question AHR at the distal airway level in obese women. Methods. A total of 293 symptomatic obese and nonobese women free of treatment were investigated. Methacholine challenge tests were undertaken, and patients were divided according to their results to the test. In hyperreactive and nonhyperreactive patients and in our total population, correlations, regression analyses, and analyses of covariance were performed to compare distal airway hyperreactivity in three groups of body mass index (BMI). Results. After adjusting for age and baseline respiratory values, the relationship between FVC and FEV1 (forced expiratory volume in one second) DRS was influenced by BMI, with a lower slope in obese than overweight and normal patients in our total population (P = 0.008) and in our nonhyperreactive one (P = 0.028). Conclusion. Distal airway hyperresponsiveness was observed in symptomatic wheezing obese women negative to methacholine challenge.
Collapse
|
371
|
|
372
|
Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, Wood LG. Dietary restriction and exercise improve airway inflammation and clinical outcomes in overweight and obese asthma: a randomized trial. Clin Exp Allergy 2013; 43:36-49. [PMID: 23278879 DOI: 10.1111/cea.12004] [Citation(s) in RCA: 204] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Revised: 07/09/2012] [Accepted: 08/02/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity and asthma are associated conditions; however, the mechanisms linking the two remain unclear. Few studies have examined the effects of weight loss on inflammation and clinical outcomes in obese-asthma. OBJECTIVE To compare the effects of weight loss achieved by dietary restriction, exercise or combined dietary restriction and exercise on airway inflammation and clinical outcomes in overweight and obese adults with asthma. METHODS Participants (n = 46; 54.3% female, body mass index (mean ± SD) 33.7 ± 3.5 kg/m(2) ) were randomized to complete a 10-week dietary, exercise or combined dietary and exercise intervention. Dual-energy x-ray absorptiometry was performed, the Juniper Asthma Control Questionnaire and Juniper Asthma Quality of Life Questionnaire completed and inflammatory markers, dietary intake and physical activity measured. The trial was registered with the Australian Clinical Trials Registry: ACTRN12611000235909. RESULTS Retention was 82.6%. Mean ± SD weight loss was 8.5 ± 4.2%, 1.8 ± 2.6% and 8.3 ± 4.9% after the dietary, exercise and combined interventions respectively. Asthma control improved after the dietary (mean ± SD; -0.6 ± 0.5, P ≤ 0.001) and combined interventions (-0.5 ± 0.7, P = 0.040), whereas quality of life improved after the dietary [median (IQR); 0.9 (0.4, 1.3), P = 0.002], exercise [0.49 (0.03, 0.78), P = 0.037] and combined [0.5 (0.1, 1.0), P = 0.007] interventions. A 5-10% weight loss resulted in clinically important improvements to asthma control in 58%, and quality of life in 83%, of subjects. Gynoid adipose tissue reduction was associated with reduced neutrophilic airway inflammation in women [β-coefficient (95% CI); 1.75 (0.02, 3.48), P = 0.047], whereas a reduction in dietary saturated fat was associated with reduced neutrophilic airway inflammation in males (r = 0.775, P = 0.041). The exercise intervention resulted in a significant reduction to sputum eosinophils [median (IQR); -1.3 (-2.0, -1.0)%, P = 0.028]. CONCLUSION AND CLINICAL RELEVANCE This study suggests a weight-loss goal of 5-10% be recommended to assist in the clinical management of overweight and obese adults with asthma. The obese-asthma phenotype may involve both innate and allergic inflammatory pathways.
Collapse
Affiliation(s)
- H A Scott
- Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW, Australia
| | | | | | | | | | | | | |
Collapse
|
373
|
Chest wall regional volumes in obese women. Respir Physiol Neurobiol 2013; 189:167-73. [PMID: 23886636 DOI: 10.1016/j.resp.2013.07.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 07/08/2013] [Accepted: 07/16/2013] [Indexed: 11/23/2022]
Abstract
Excess body fat, particularly in the abdominal region, is responsible for respiratory system alterations. To study if and how both lung function and thoraco-abdominal volume variations during quiet breathing are altered in obese women and to determine if different obesity patterns in women have an influence on lung and chest wall function, 30 obese women (BMI ≥ 40 kg/m(2)) with both central and peripheral obesity were studied by spirometry and opto-electronic plethysmography during quiet breathing and compared with normoweight women. Compared to controls, obese were characterized by lung restriction and higher minute ventilation at rest. Pulmonary rib cage tidal volume variations were significantly lower and abdominal volume variations higher in obese women. No differences were found between central and peripheral obese women. In conclusion, in obese women, independently if obesity is central or peripheral, both lung function and thoraco-abdominal pattern during spontaneous breathing are strongly altered. The amount of fat in the abdominal compartment, and not the peripheral, alters the respiratory system.
Collapse
|
374
|
Obesity and asthma: physiological perspective. J Allergy (Cairo) 2013; 2013:198068. [PMID: 23970905 PMCID: PMC3732624 DOI: 10.1155/2013/198068] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2013] [Revised: 05/27/2013] [Accepted: 07/03/2013] [Indexed: 12/19/2022] Open
Abstract
Obesity induces some pertinent physiological changes which are conducive to either development of asthma or cause of poorly controlled asthma state. Obesity related mechanical stress forces induced by abdominal and thoracic fat generate stiffening of the lungs and diaphragmatic movements to result in reduction of resting lung volumes such as functional residual capacity (FRC). Reduced FRC is primarily an outcome of decreased expiratory reserve volume, which pushes the tidal breathing more towards smaller high resistance airways, and consequentially results in expiratory flow limitation during normal breathing in obesity. Reduced FRC also induces plastic alteration in the small collapsible airways, which may generate smooth muscle contraction resulting in increased small airway resistance, which, however, is not picked up by spirometric lung volumes. There is also a possibility that chronically reduced FRC may generate permanent adaptation in the very small airways; therefore, the airway calibres may not change despite weight reduction. Obesity may also induce bronchodilator reversibility and diurnal lung functional variability. Obesity is also associated with airway hyperresponsiveness; however, the mechanism of this is not clear. Thus, obesity has effects on lung function that can generate respiratory distress similar to asthma and may also exaggerate the effects of preexisting asthma.
Collapse
|
375
|
Chen YS, Li XQ, Li HR, Miao Y, Lian SQ, Lu FF, Yu XL, Lin YH, Liu T. Risk factors for small airway obstruction among Chinese island residents: a case-control study. PLoS One 2013; 8:e68556. [PMID: 23874670 PMCID: PMC3715483 DOI: 10.1371/journal.pone.0068556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/29/2013] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND We investigated the prevalence of and risk factors for small airway obstruction (SAO) among Chinese island residents to establish means to prevent and treat SAO. METHODS From October 17, 2011 to November 1, 2011, a total of 2,873 residents aged >20 years who lived on the Huangqi Peninsula of Fujian were recruited by random cluster sampling. They were asked to complete a Burden of Obstructive Lung Disease (BOLD) questionnaire and underwent physical examinations and lung function evaluations. SAO was defined as a forced expiratory flow at 50% of vital capacity, Vmax50%, of less than 70% of predicted. Risk factors for SAO were assessed from among demographic and anthropometric variables, blood chemistry results, and questionnaire response items. RESULTS A total of 216 (7.52%) Chinese island residents were identified as having SAO (95 males; 121 females). Their survey and test results were compared with 432 age and sex-matched healthy controls (192 males; 240 females) for SAO risk factors. Among numerous factors investigated, only diabetes mellitus (p = 0.039), smoking index (SI, p<0.001 for SI>600), second hand smoke (p = 0.002), and lack of regular exercise (p<0.001) were significant risk factors for SAO. CONCLUSIONS The risk factors for SAO among Chinese island residents appeared to be similar to those among people who live in high-density urban environments and impoverished rural areas. Public health policies and medical practices directed toward improving respiratory health for island residents should be comparable to those used for urban and rural dwellers.
Collapse
Affiliation(s)
- Yu-sheng Chen
- Department of Respiratory Medicine, Fujian Provincial Hospital, Provincial Clinic College of Fujian Medical University, Fuzhou, Fujian Province, PR China.
| | | | | | | | | | | | | | | | | |
Collapse
|
376
|
Khan S, Mai XM, Chen Y. Plasma 25-hydroxyvitamin D associated with pulmonary function in Canadian adults with excess adiposity. Am J Clin Nutr 2013; 98:174-9. [PMID: 23656903 DOI: 10.3945/ajcn.112.054734] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Vitamin D deficiency is an important health issue, particularly among people residing in northern countries. Low concentrations of 25-hydroxyvitamin D [25(OH)D] have been linked to several health conditions. OBJECTIVE The objective was to determine the association between plasma 25(OH)D and pulmonary function and the effect modifications of sex and body mass index (BMI) in adults. DESIGN A cross-sectional study included 3359 adults aged ≥18 y who participated in the Canadian Health Measures Survey, and a 2-stage multiple linear regression analysis was conducted. RESULTS Overall, 26% of the adults had a plasma 25(OH)D concentration <50 nmol/L, which is considered deficient (ie, hypovitaminosis D). This deficiency was more prevalent among men than among women (30% compared with 23%). Regression analysis showed that deficient plasma 25(OH)D was associated with lower mean residual forced vital capacity and forced expiratory volume in 1 s in men after adjustment for covariates. When further stratified by BMI, the associations were more marked in overweight and obese men. Vitamin D deficiency associated with pulmonary function was not statistically significant in normal-weight men or in women, regardless of BMI categories. Similar results were obtained when plasma 25(OH)D was examined as a continuous variable in the models. CONCLUSIONS Hypovitaminosis D may be a risk factor for lung dysfunction, especially for overweight and obese men. Further research is necessary to determine the mechanism of the interrelation between vitamin D, adiposity, and pulmonary function.
Collapse
Affiliation(s)
- Sara Khan
- Department of Epidemiology and Community Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | | |
Collapse
|
377
|
Bernhardt V, Lorenzo S, Babb TG, Zavorsky GS. Corrected end-tidal P(CO(2)) accurately estimates Pa(CO(2)) at rest and during exercise in morbidly obese adults. Chest 2013; 143:471-477. [PMID: 22878275 DOI: 10.1378/chest.12-0896] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Obesity affects lung function and gas exchange and imposes mechanical ventilatory limitations during exercise that could disrupt the predictability of Pa(CO(2)) from end-tidal P(CO(2)) (P(ETCO(2))), an important clinical tool for assessing gas exchange efficiency during exercise testing. Pa(CO(2)) has been estimated during exercise with good accuracy in normal-weight individuals by using a correction equation developed by Jones and colleagues (P(JCO(2)) = 5.5 + 0.9 x P(ETCO(2)) – 2.1 x tidal volume). The purpose of this project was to determine the accuracy of Pa(CO(2)) estimations from P(ETCO(2)) and P(JCO(2)) values at rest and at submaximal and peak exercise in morbidly obese adults. METHODS Pa(CO(2)) and P(ETCO(2)) values from 37 obese adults (22 women, 15 men; age, 39 ± 9 y; BMI, 49 ± 7; [mean ± SD]) were evaluated. Subjects underwent ramped cardiopulmonary exercise testing to volitional exhaustion. P(ETCO(2)) was determined from expired gases simultaneously with temperature-corrected arterial blood gases (radial arterial catheter) at rest, every minute during exercise, and at peak exercise. Data were analyzed using paired t tests. RESULTS P(ETCO(2)) was not significantly different from Pa(CO(2)) at rest (P(ETCO(2)) = 37 ± 3 mm Hg vs Pa(CO(2)) = 38 ± 3 mm Hg, P = .14). However, during exercise, P(ETCO(2)) was significantly higher than Pa(CO(2)) (submaximal: 42 ± 4 vs 40 ± 3, P < .001; peak: 40 ± 4 vs 37 ± 4, P < .001, respectively). Jones’ equation successfully corrected P(ETCO(2)), such that P(JCO(2)) was not significantly different from Pa(CO(2)) (submax: P(JCO(2)) = 40 ± 3, P = .650; peak: 37 ± 4, P = .065). CONCLUSION P(JCO(2)) provides a better estimate of Pa(CO(2)) than P(ETCO(2)) during submaximal exercise and at peak exercise, whereas at rest both yield reasonable estimates in morbidly obese individuals. Clinicians and physiologists can obtain accurate estimations of Pa(CO(2)) in morbidly obese individuals by using P(JCO(2)).
Collapse
Affiliation(s)
- Vipa Bernhardt
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX
| | - Santiago Lorenzo
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX
| | - Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and University of Texas Southwestern Medical Center, Dallas, TX.
| | | |
Collapse
|
378
|
Bethea TN, Rosenberg L, Charlot M, O'Connor GT, Adams-Campbell LL, Palmer JR. Obesity in relation to lung cancer incidence in African American women. Cancer Causes Control 2013; 24:1695-703. [PMID: 23744044 DOI: 10.1007/s10552-013-0245-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 05/29/2013] [Indexed: 01/01/2023]
Abstract
PURPOSE Although a number of studies have found an inverse association between body mass index (BMI) and risk of lung cancer, there is little information on this relation in African Americans, who experience a higher incidence of lung cancer. METHODS We assessed the relation of BMI to incidence of lung cancer in the Black Women's Health Study, an ongoing prospective follow-up of 59,000 women in the USA. Cox proportional hazard models were used to estimate hazard ratios for various levels of BMI relative to BMI 18.5-24.9 kg/m2 ("normal weight") with adjustment for age, education, pack-years of smoking, and other covariates. Two other anthropometric measures, waist circumference (WC) and waist/hip ratio (WHR), were also assessed. A total of 323 primary lung cancer cases were identified from 1995 to 2011. RESULTS The hazard ratio (HR) for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.69 (95% CI 0.51-0.92). As expected, cigarette smoking was strongly associated with increased risk of lung cancer. In analyses stratified by smoking status, the HR for BMI ≥ 30 relative to BMI 18.5-24.9 was 0.62 (0.38-1.00) among current smokers, 0.90 (0.56-1.42) among former smokers, and 0.83 (0.41-1.70) among never smokers (p for interaction = 0.28). Control for pack-years of smoking or age started smoking had little effect on the hazard ratios. WC and WHR were not materially associated with lung cancer risk. CONCLUSION Our results indicate that high BMI is associated with a lower risk of lung cancer in African American women, particularly among current smokers.
Collapse
Affiliation(s)
- Traci N Bethea
- Slone Epidemiology Center, Boston University, 1010 Commonwealth Avenue, Boston, MA, 02215, USA,
| | | | | | | | | | | |
Collapse
|
379
|
Babb TG. Obesity: challenges to ventilatory control during exercise--a brief review. Respir Physiol Neurobiol 2013; 189:364-70. [PMID: 23707540 DOI: 10.1016/j.resp.2013.05.019] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2013] [Revised: 05/14/2013] [Accepted: 05/15/2013] [Indexed: 10/26/2022]
Abstract
Obesity is a national health issue in the US. Among the many physiological changes induced by obesity, it also presents a unique challenge to ventilatory control during exercise due to increased metabolic demand of moving larger limbs, increased work of breathing due to extra weight on the chest wall, and changes in breathing mechanics. These challenges to ventilatory control in obesity can be inconspicuous or overt among obese adults but for the most part adaptation of ventilatory control during exercise in obesity appears remarkably unnoticed in the majority of obese people. In this brief review, the changes to ventilatory control required for maintaining normal ventilation during exercise will be examined, especially the interaction between respiratory neural drive and ventilation. Also, gaps in our current knowledge will be discussed.
Collapse
Affiliation(s)
- Tony G Babb
- Institute for Exercise and Environmental Medicine, Texas Health Presbyterian Hospital Dallas and Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75231, United States.
| |
Collapse
|
380
|
Schulz H, Flexeder C, Behr J, Heier M, Holle R, Huber RM, Jörres RA, Nowak D, Peters A, Wichmann HE, Heinrich J, Karrasch S. Reference values of impulse oscillometric lung function indices in adults of advanced age. PLoS One 2013; 8:e63366. [PMID: 23691036 PMCID: PMC3655177 DOI: 10.1371/journal.pone.0063366] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2013] [Accepted: 03/30/2013] [Indexed: 11/18/2022] Open
Abstract
Background Impulse oscillometry (IOS) is a non-demanding lung function test. Its diagnostic use may be particularly useful in patients of advanced age with physical or mental limitations unable to perform spirometry. Only few reference equations are available for Caucasians, none of them covering the old age. Here, we provide reference equations up to advanced age and compare them with currently available equations. Methods IOS was performed in a population-based sample of 1990 subjects, aged 45–91 years, from KORA cohorts (Augsburg, Germany). From those, 397 never-smoking, lung healthy subjects with normal spirometry were identified and sex-specific quantile regression models with age, height and body weight as predictors for respiratory system impedance, resistance, reactance, and other parameters of IOS applied. Results Women (n = 243) showed higher resistance values than men (n = 154), while reactance at low frequencies (up to 20 Hz) was lower (p<0.05). A significant age dependency was observed for the difference between resistance values at 5 Hz and 20 Hz (R5–R20), the integrated area of low-frequency reactance (AX), and resonant frequency (Fres) in both sexes whereas reactance at 5 Hz (X5) was age dependent only in females. In the healthy subjects (n = 397), mean differences between observed values and predictions for resistance (5 Hz and 20 Hz) and reactance (5 Hz) ranged between −1% and 5% when using the present model. In contrast, differences based on the currently applied equations (Vogel & Smidt 1994) ranged between −34% and 76%. Regarding our equations the indices were beyond the limits of normal in 8.1% to 18.6% of the entire KORA cohort (n = 1990), and in 0.7% to 9.4% with the currently applied equations. Conclusions Our study provides up-to-date reference equations for IOS in Caucasians aged 45 to 85 years. We suggest the use of the present equations particularly in advanced age in order to detect airway dysfunction.
Collapse
Affiliation(s)
- Holger Schulz
- Institute of Epidemiology I, Helmholtz Zentrum München, Munich, Germany.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
381
|
Abstract
Asthma is a chronic disorder affecting millions of people worldwide. The prevalence of asthma is around 300 million and is expected to increase another 100 million by 2025. Obesity, on the other hand, also affects a large number of individuals. Overweight in adults is defined when body mass index (BMI) is between 25 to 30 kg/m(2) and obesity when the BMI >30 kg/m(2). It has been a matter of interest for researchers to find a relation between these two conditions. This knowledge will provide a new insight into the management of both conditions. At present, obese asthma patients may be considered a special category and it is important to assess the impact of management of obesity on asthma symptoms.
Collapse
|
382
|
Tenório LHS, Santos AC, Câmara Neto JB, Amaral FJ, Passos VMM, Lima AMJ, Brasileiro-Santos MDS. The influence of inspiratory muscle training on diaphragmatic mobility, pulmonary function and maximum respiratory pressures in morbidly obese individuals: a pilot study. Disabil Rehabil 2013; 35:1915-20. [DOI: 10.3109/09638288.2013.769635] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
|
383
|
Airway management in obese patients. Surg Obes Relat Dis 2013; 9:809-15. [PMID: 23810609 DOI: 10.1016/j.soard.2013.04.013] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2013] [Revised: 04/20/2013] [Accepted: 04/26/2013] [Indexed: 12/17/2022]
Abstract
The well-known difficulties in airway management in obese patients are caused by obesity-related airways and respiratory changes. Anesthesiologists confront a number of troubles, including rapid oxygen desaturation, difficulty with laryngoscopy/intubation and mask ventilation, and increased susceptibility to the respiratory depressant effects of anesthetic drugs. Preoperative assessment of the airways in the obese should include examination of specific predictors of difficult mask ventilation other than those for difficult intubation. Difficulties in airway management are decreased after providing optimal preoxygenation and positioning ("ramped"). Other strategies may include availability of alternative airway management devices, including new video laryngoscopes that significantly improve the visualization of the larynx and thereby facilitate intubation. If awake intubation is mandatory, it may be performed with fibrobronchoscope after providing an adequate topical anesthesia and sedation with short-acting drugs, such as remifentanil. Succinylcholine for rapid sequence induction might be replaced by rocuronium where sugammadex is available for reversal. A complete reversal of neuromuscular block, measured by train-of-four monitoring, should be obtained before extubation, which requires a fully awake patient in the same position with airway equipment used for intubation.
Collapse
|
384
|
|
385
|
Wenger S, Hoby S, Wyss F, Adami C, Wenker C. Anaesthesia with medetomidine, midazolam and ketamine in six gorillas after premedication with oral zuclopenthixol dihydrochloride. Vet Anaesth Analg 2013; 40:176-80. [DOI: 10.1111/j.1467-2995.2012.00761.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
386
|
Testerman GM, Breitman I, Hensley S. Airway Pressure Release Ventilation in Morbidly Obese Surgical Patients with Acute Lung Injury and Acute Respiratory Distress Syndrome. Am Surg 2013. [DOI: 10.1177/000313481307900320] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Morbidly obese patients with body mass index greater than 40 kg/m2 and respiratory failure requiring critical care services are increasingly seen in trauma and acute care surgical centers. Baseline respiratory pathophysiology including decreased pulmonary compliance with dependent atelectasis and abnormal ventilation–perfusion relationships predisposes these patients to acute lung injury (ALI) and adult respiratory distress syndrome (ARDS) as well as prolonged stays in the intensive care unit. Airway pressure release ventilation (APRV) is an increasingly used alternative mode for salvage therapy in patients with hypoxemic respiratory failure that also provides lung protection from ventilator-induced lung injury. APRV provides the conceptual advantage of an “open lung” approach to ventilation that may be extended to the morbidly obese patient population with ALI and ARDS. We discuss the theoretical benefits and a recent clinical experience of APRV ventilation in the morbidly obese patient with respiratory failure at a Level I trauma, surgical critical care, and acute care surgery center.
Collapse
Affiliation(s)
- George M. Testerman
- From the Holston Valley Hospital Level 1 Trauma Center, Department of Surgery, ETSU College of Medicine, Kingsport, Tennessee
| | - Igal Breitman
- From the Holston Valley Hospital Level 1 Trauma Center, Department of Surgery, ETSU College of Medicine, Kingsport, Tennessee
| | - Sarah Hensley
- From the Holston Valley Hospital Level 1 Trauma Center, Department of Surgery, ETSU College of Medicine, Kingsport, Tennessee
| |
Collapse
|
387
|
Benden C, Ridout DA, Edwards LB, Boehler A, Christie JD, Sweet SC. Body mass index and its effect on outcome in children after lung transplantation. J Heart Lung Transplant 2013. [DOI: 10.1016/j.healun.2012.11.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
388
|
Rovira Soriano L, Belda Nácher J. Postoperative respiratory management of morbidly obese patient. TRENDS IN ANAESTHESIA AND CRITICAL CARE 2013. [DOI: 10.1016/j.tacc.2012.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
389
|
Wehrmeister FC, Menezes AMB, Muniz LC, Martínez-Mesa J, Domingues MR, Horta BL. Waist circumference and pulmonary function: a systematic review and meta-analysis. Syst Rev 2012; 1:55. [PMID: 23153289 PMCID: PMC3534560 DOI: 10.1186/2046-4053-1-55] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2012] [Accepted: 10/18/2012] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Studies have reported an impact of central obesity on people's health. The literature is scarce on the effects of waist circumference (WC) on pulmonary function. Our objective was to review the literature on the association between WC and pulmonary function. METHODS A systematic review was carried out in the PubMed, CINAHL, Web of Science and Scopus databases. The search included published, in press and online documents up to December 2011. A meta-analysis was carried out to obtain the pooled effect, and a meta-regression was performed to evaluate sources of heterogeneity. RESULTS From the 547 studies identified, 10 were included. The meta-analysis revealed an inverse relationship between WC and pulmonary function parameters, indicating that the effect was greater among men (forced expiratory volume in 1 second (FEV1 β = -15.9 (95% confidence interval = -23.2, -8.5); forced vital capacity (FVC) β = -16.6 (95% confidence interval = -21.0, -12.2)) compared with women (FEV1 β = -5.6 (95% confidence interval = -9.1, -2.1); FVC β = -7.0 (95% confidence interval = -9.1, -4.8)). The meta-regression identified sex as the characteristic that most contributed to the heterogeneity (R2 = 54.8% for FEV1 and R2 = 85.7% for FVC). CONCLUSIONS There seems to be an inverse relationship between WC and pulmonary function, mainly in men. More population-based studies should be performed, especially among children and adolescents, to confirm these findings.
Collapse
Affiliation(s)
- Fernando César Wehrmeister
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Rua Marechal Deodoro 1160, 3º Piso, Pelotas, RS, CEP 96020-220, Brazil.
| | | | | | | | | | | |
Collapse
|
390
|
|
391
|
Starren ES, Roberts NJ, Tahir M, O'Byrne L, Haffenden R, Patel IS, Partridge MR. A centralised respiratory diagnostic service for primary care: a 4-year audit. PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:180-6. [PMID: 22430040 DOI: 10.4104/pcrj.2012.00013] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND The literature shows that delayed or erroneous diagnosis of respiratory conditions may be common in primary care due to underuse of spirometry or poor spirometric technique. The Community Respiratory Assessment Unit (CRAU) was established to optimise diagnosis and treatment of respiratory disease by providing focused history-taking, quality-assured spirometry, and evidence-based guideline-derived management advice. AIMS To review the service provided by the CRAU to primary care health professionals. METHODS Data from 1,156 consecutive GP referrals over 4 years were analysed. RESULTS From the 1,156 referrals, 666 were referred for one of five common reasons: suspected asthma, confirmed asthma, suspected chronic obstructive pulmonary disease (COPD), confirmed COPD, or unexplained breathlessness. COPD was the most prevalent referral indication (445/666, 66.8%), but one-third of suggested diagnoses of COPD by the GP were found to be incorrect (161/445, 36%) with inappropriate prescribing of inhaled therapies resulting from this misdiagnosis. Restrictive pulmonary defects (56/666, 8% of referrals) were overlooked and often mistaken for obstructive conditions. The potential for obesity to cause breathlessness may not be fully appreciated. CONCLUSIONS Misdiagnosis has significant financial, ethical, and safety implications. This risk may be minimised by better support for primary care physicians such as diagnostic centres (CRAU) or alternative peripatetic practice-based services operating to quality-controlled standards.
Collapse
Affiliation(s)
- Elizabeth S Starren
- Imperial College London, NHLI Division at Charing Cross Hospital, London, UK
| | | | | | | | | | | | | |
Collapse
|
392
|
Respiratory Consequences of Mild-to-Moderate Obesity: Impact on Exercise Performance in Health and in Chronic Obstructive Pulmonary Disease. Pulm Med 2012; 2012:818925. [PMID: 23097698 PMCID: PMC3477561 DOI: 10.1155/2012/818925] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2012] [Accepted: 08/26/2012] [Indexed: 02/04/2023] Open
Abstract
In many parts of the world, the prevalence of obesity is increasing at an alarming rate. The association between obesity, multiple comorbidities, and increased mortality is now firmly established in many epidemiological studies. However, the link between obesity and exercise intolerance is less well studied and is the focus of this paper. Although exercise limitation is likely to be multifactorial in obesity, it is widely believed that the respiratory mechanical constraints and the attendant dyspnea are important contributors. In this paper, we examined the evidence that critical ventilatory constraint is a proximate source of exercise limitation in individuals with mild-to-moderate obesity. We first reviewed existing information on exercise performance, including ventilatory and perceptual response patterns, in obese individuals who are otherwise healthy. We then considered the impact of obesity in patients with preexisting respiratory mechanical abnormalities due to chronic obstructive pulmonary disease (COPD), with particular reference to the effect on dyspnea and exercise performance. Our main conclusion, based on the existing and rather sparse literature on the subject, is that abnormalities of dynamic respiratory mechanics are not likely to be the dominant source of dyspnea and exercise intolerance in otherwise healthy individuals or in patients with COPD with mild-to-moderate obesity.
Collapse
|
393
|
Ye Z, Huang Y, Liu D, Chen X, Wang D, Huang D, Zhao L, Xiao X. Obesity induced by neonatal overfeeding worsens airway hyperresponsiveness and inflammation. PLoS One 2012; 7:e47013. [PMID: 23056561 PMCID: PMC3466258 DOI: 10.1371/journal.pone.0047013] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Accepted: 09/11/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Obesity is a risk factor for the development of certain respiratory diseases, and neonatal overfeeding results in an early onset of obesity in adulthood. However, the influence of neonatal overfeeding on respiratory diseases has rarely been studied. Therefore, this paper is aimed at investigating the effect of neonatal overfeeding on airway responsiveness and inflammation. METHODOLOGY/PRINCIPAL FINDINGS The neonatal overfeeding was induced by reducing litter size to three pups per litter (small litter, SL) in contrast to the normal litter size with ten pups per litter (NL) on postnatal day 3 (P3) in male ICR mice. On P21, mice were weaned to standard chow diet. Airway responsiveness to methacholine was measured either on P21 or P150. Total and classified inflammatory cells in bronchoalveolar lavage fluid (BALF) were counted, lung inflammatory cells were evaluated through staining with hematoxylin & eosin and F4/80 immunohistochemistry; lung fibrosis was evaluated through staining with Masson and α-SAM immunohistochemistry. Leptin levels in serum were measured by RIA; TNF-α levels in serum and BALF were quantified by ELISA; mRNA levels of TNF-α, CTGF and TGF-β1 in lung tissues were measured using real-time PCR. Mice from SL exhibited accelerated body weight gain, impaired glucose tolerance and hyperleptinemia. Enhanced airway responsiveness to methacholine was observed in SL mice on P150, but not on P21. Pulmonary inflammation was evident in SL mice on P150, as reflected by inflammatory cells especially macrophages around bronchi and interstitium. BALF and serum TNF-α levels and lung TNF-α mRNA expression were significantly increased in SL mice on P150. More collagen accumulated surrounding the bronchi on P150; lung mRNA levels of TGF-β1 and CTGF were also increased on P150. CONCLUSION In addition to inducing a variety of metabolic defects, neonatal overfeeding enhanced lung inflammation, which may lead to airway remodeling and airway hyperresponsiveness in adulthood.
Collapse
Affiliation(s)
- Zehui Ye
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Department of Respiratory Medicine, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Ying Huang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Department of Respiratory Medicine, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
| | - Dan Liu
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Xiaoyi Chen
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Dongjuan Wang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Department of Respiratory Medicine, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, Chongqing, China
| | - Daochao Huang
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
| | - Li Zhao
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
| | - Xiaoqiu Xiao
- Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Medical University, Chongqing, China
- Chongqing Key Laboratory of Translational Medical Research in Cognitive Development and Learning and Memory Disorders, Chongqing Medical University, Chongqing, China
- Key Laboratory of Pediatrics in Chongqing, Chongqing Medical University, Chongqing, China
- Chongqing International Science and Technology Cooperation Center for Child Development and Disorders, Children’s Hospital, Chongqing Medical University, Chongqing, China
| |
Collapse
|
394
|
Campana LM, Malhotra A, Suki B, Hess L, Israel E, Smales E, Deyoung P, Owens RL. The effect of lung stretch during sleep on airway mechanics in overweight and obese asthma. Respir Physiol Neurobiol 2012; 185:304-12. [PMID: 23041446 DOI: 10.1016/j.resp.2012.09.013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2012] [Revised: 09/24/2012] [Accepted: 09/26/2012] [Indexed: 11/18/2022]
Abstract
Both obesity and sleep reduce lung volume and limit deep breaths, possibly contributing to asthma. We hypothesize that increasing lung volume dynamically during sleep would reduce airway resistance in asthma. Asthma (n=10) and control (n=10) subjects were studied during sleep at baseline and with increased lung volume via bi-level positive airway pressure (BPAP). Using forced oscillations, respiratory system resistance (R(rs)) and reactance (X(rs)) were measured during sleep and R(rs) was partitioned to upper and lower airway resistance (R(up), R(low)) using an epiglottic pressure catheter. R(rs) and R(up) increased with sleep (p<0.01) and X(rs) was decreased in REM (p=0.02) as compared to wake. R(rs), R(up), and R(low), were larger (p<0.01) and X(rs) was decreased (p<0.02) in asthma. On BPAP, R(rs) and R(up) were decreased (p<0.001) and X(rs) increased (p<0.01), but R(low) was unchanged. High R(up) was observed in asthma, which reduced with BPAP. We conclude that the upper airway is a major component of R(rs) and larger lung volume changes may be required to alter R(low).
Collapse
Affiliation(s)
- L M Campana
- Department of Biomedical Engineering, Boston University, Boston, MA, United States.
| | | | | | | | | | | | | | | |
Collapse
|
395
|
Launois C, Barbe C, Bertin E, Nardi J, Perotin JM, Dury S, Lebargy F, Deslee G. The modified Medical Research Council scale for the assessment of dyspnea in daily living in obesity: a pilot study. BMC Pulm Med 2012; 12:61. [PMID: 23025326 PMCID: PMC3515513 DOI: 10.1186/1471-2466-12-61] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2012] [Accepted: 09/22/2012] [Indexed: 11/19/2022] Open
Abstract
Background Dyspnea is very frequent in obese subjects. However, its assessment is complex in clinical practice. The modified Medical Research Council scale (mMRC scale) is largely used in the assessment of dyspnea in chronic respiratory diseases, but has not been validated in obesity. The objectives of this study were to evaluate the use of the mMRC scale in the assessment of dyspnea in obese subjects and to analyze its relationships with the 6-minute walk test (6MWT), lung function and biological parameters. Methods Forty-five obese subjects (17 M/28 F, BMI: 43 ± 9 kg/m2) were included in this pilot study. Dyspnea in daily living was evaluated by the mMRC scale and exertional dyspnea was evaluated by the Borg scale after 6MWT. Pulmonary function tests included spirometry, plethysmography, diffusing capacity of carbon monoxide and arterial blood gases. Fasting blood glucose, total cholesterol, triglyceride, N-terminal pro brain natriuretic peptide, C-reactive protein and hemoglobin levels were analyzed. Results Eighty-four percent of patients had a mMRC ≥ 1 and 40% a mMRC ≥ 2. Compared to subjects with no dyspnea (mMRC = 0), a mMRC ≥ 1 was associated with a higher BMI (44 ± 9 vs 36 ± 5 kg/m2, p = 0.01), and a lower expiratory reserve volume (ERV) (50 ± 31 vs 91 ± 32%, p = 0.004), forced expiratory volume in one second (FEV1) (86 ± 17 vs 101 ± 16%, p = 0.04) and distance covered in 6MWT (401 ± 107 vs 524 ± 72 m, p = 0.007). A mMRC ≥ 2 was associated with a higher Borg score after the 6MWT (4.7 ± 2.5 vs 6.5 ± 1.5, p < 0.05). Conclusion This study confirms that dyspnea is very frequent in obese subjects. The differences between the “dyspneic” and the “non dyspneic” groups assessed by the mMRC scale for BMI, ERV, FEV1 and distance covered in 6MWT suggests that the mMRC scale might be an useful and easy-to-use tool to assess dyspnea in daily living in obese subjects.
Collapse
Affiliation(s)
- Claire Launois
- Service des Maladies Respiratoires, INSERM UMRS 903, Hôpital Maison Blanche, CHU de Reims, Reims, Cedex, France.
| | | | | | | | | | | | | | | |
Collapse
|
396
|
Mafort TT, Madeira E, Madeira M, Guedes EP, Moreira RO, de Mendonça LMC, Farias MLF, Lopes AJ. Intragastric balloon for the treatment of obesity: evaluation of pulmonary function over a 3-month period. Lung 2012; 190:671-6. [PMID: 22968677 DOI: 10.1007/s00408-012-9415-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2012] [Accepted: 08/30/2012] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity has become a global epidemic in the 21st century, and the placement of an intragastric balloon (IB) is a therapeutic modality used to treat it. Our objectives for this study were to evaluate changes in lung function resulting from IB use and to correlate the pattern of body fat distribution with changes in lung function. METHODS This was an interventional study with 30 overweight and obese patients with metabolic syndrome. All of the subjects underwent anthropometric measurements, assessment of their body fat distribution pattern by dual-energy X-ray absorptiometry, and pulmonary function testing before implantation of the IB. RESULTS During the initial evaluations, the main pulmonary function abnormalities observed were decreased expiratory reserve volume (ERV), decreased total lung capacity (TLC), and increased diffusing capacity of carbon monoxide (DL(CO)), which occurred in 56.7, 40, and 23.3 % of patients, respectively. We observed a statistically significant positive correlation between the DL(CO) and the percentage of trunk fat mass (ρ = 0.42; p < 0.01). Three months after placement of the IB, there was a significant reduction in the body mass index (p < 0.0001) and the maximal inspiratory pressure (p < 0.009). We also observed a significant increase in the forced vital capacity (p < 0.0001), TLC (p < 0.001), and ERV (p < 0.0001). CONCLUSIONS Weight loss as a result of IB causes increased static lung volumes and decreased inspiratory muscle strength. Additionally, being overweight and obese is related to increased DL(CO), especially in individuals with truncal obesity.
Collapse
Affiliation(s)
- Thiago Thomaz Mafort
- Postgraduate Program in Medical Sciences, State University of Rio de Janeiro, Rua Araguaia, 1266, bloco 1/405, Freguesia, Jacarepaguá, Rio de Janeiro, RJ, 22745-271, Brazil
| | | | | | | | | | | | | | | |
Collapse
|
397
|
Abstract
The incidence of obesity has acquired an epidemic proportion throughout the globe. As a result, increasing number of obese patients is being presented to critical care units for various indications. The attending intensivist has to face numerous challenges during management of such patients. Almost all the organ systems are affected by the impact of obesity either directly or indirectly. The degree of obesity and its prolong duration are the main factors which determine the harmful effect of obesity on human body. The present article reviews few of the important clinical and critical care concerns in critically ill obese patients.
Collapse
Affiliation(s)
- Sukhminder Jit Singh Bajwa
- Department of Anaesthesiology and Intensive Care, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| | - Vishal Sehgal
- Department of Internal Medicine, The Commonwealth Medical College Scranton, PA 18510, USA
| | - Sukhwinder Kaur Bajwa
- Department of Obstetrics and Gynaecology, Gian Sagar Medical College and Hospital, Ram Nagar, Banur, Punjab, India
| |
Collapse
|
398
|
Distal airway dysfunction in obese subjects corrects after bariatric surgery. Surg Obes Relat Dis 2012; 8:582-9. [DOI: 10.1016/j.soard.2011.08.004] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/25/2011] [Accepted: 08/05/2011] [Indexed: 11/19/2022]
|
399
|
Abstract
Obesity is associated with risk of pulmonary disease, and adversely affects lung function. The parallel increase in obesity and asthma suggests the two conditions are linked; indeed, they can worsen each other. Obesity and inadequate asthma control are associated with poor quality of life, and place a high economic burden on public health. Although the obesity-lung interaction is a major issue for basic research and clinical studies, various questions remain unanswered. Do intrauterine and early life factors impact on the development of obesity and lung disease? If so, can this be prevented? Asthma is generally more severe in obese subjects, but is adiposity a driver of a new asthma phenotype that features greater morbidity and mortality, worse control and decreased response to medications? Obese individuals have small lung volumes, hence their airway calibre is reduced and airway resistance is increased. What puzzles physicians is whether peripheral airways undergo remodelling, which would increase bronchoconstriction. Obese asthmatics respond suboptimally to anti-inflammatory treatment, which raises the question: 'what drug for what patient?' Life expectancy is decreased in obesity and in chronic pulmonary disorders, but does obesity protect against or trigger chronic obstructive pulmonary disease? The time has come to find answers to these questions.
Collapse
Affiliation(s)
- F Santamaria
- Department of Paediatrics, Federico II University, Naples, Italy
| | | | | |
Collapse
|
400
|
Thun GA, Ferrarotti I, Imboden M, Rochat T, Gerbase M, Kronenberg F, Bridevaux PO, Zemp E, Zorzetto M, Ottaviani S, Russi EW, Luisetti M, Probst-Hensch NM. SERPINA1 PiZ and PiS heterozygotes and lung function decline in the SAPALDIA cohort. PLoS One 2012; 7:e42728. [PMID: 22912729 PMCID: PMC3418297 DOI: 10.1371/journal.pone.0042728] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 07/11/2012] [Indexed: 12/27/2022] Open
Abstract
Background Severe alpha1-antitrypsin (AAT) deficiency is a strong risk factor for COPD. But the impact of gene variants resulting in mild or intermediate AAT deficiency on the longitudinal course of respiratory health remains controversial. There is indication from experimental studies that pro-inflammatory agents like cigarette smoke can interact with these variants and thus increase the risk of adverse respiratory health effects. Therefore, we tested the effect of the presence of a protease inhibitor (Pi) S or Z allele (PiMS and PiMZ) on the change in lung function in different inflammation-exposed subgroups of a large, population-based cohort study. Methodology and Principal Findings The SAPALDIA population includes over 4600 subjects from whom SERPINA1 genotypes for S and Z alleles, spirometry and respiratory symptoms at baseline and after 11 years follow-up, as well as proxies for inflammatory conditions, such as detailed smoking history, obesity and high sensitivity C-reactive protein (hs-CRP), were available. All analyses were performed by applying multivariate regression models. There was no overall unfavourable effect of PiMS or PiMZ genotype on lung function change. We found indication that PiZ heterozygosity interacted with inflammatory stimuli leading to an accelerated decline in measures in use as indices for assessing mild airway obstruction. Obese individuals with genotype PiMM had an average annual decline in the forced mid expiratory flow (ΔFEF25-75%) of 58.4 ml whereas in obese individuals with PiMZ it amounted to 92.2 ml (p = 0.03). Corresponding numbers for persistent smokers differed even more strongly (66.8 ml (PiMM) vs. 108.2 ml (PiMZ), p = 0.005). Equivalent, but less strong associations were observed for the change in the FEV1/FVC ratio. Conclusions We suggest that, in addition to the well established impact of the rare PiZZ genotype, one Z allele may be sufficient to accelerate lung function decline in population subgroups characterized by elevated levels of low grade inflammation.
Collapse
Affiliation(s)
- Gian-Andri Thun
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Ilaria Ferrarotti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Institute for Respiratory Disease, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Medea Imboden
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Thierry Rochat
- Division of Pulmonary Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Margaret Gerbase
- Division of Pulmonary Medicine, University Hospital of Geneva, Geneva, Switzerland
| | - Florian Kronenberg
- Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Innsbruck Medical University, Innsbruck, Austria
| | | | - Elisabeth Zemp
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
| | - Michele Zorzetto
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Institute for Respiratory Disease, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Stefania Ottaviani
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Institute for Respiratory Disease, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Erich W. Russi
- Pulmonary Division, University Hospital of Zurich, Zurich, Switzerland
| | - Maurizio Luisetti
- Center for Diagnosis of Inherited Alpha1-antitrypsin Deficiency, Institute for Respiratory Disease, IRCCS San Matteo Hospital Foundation, University of Pavia, Pavia, Italy
| | - Nicole M. Probst-Hensch
- Swiss Tropical and Public Health Institute, Basel, Switzerland
- University of Basel, Basel, Switzerland
- * E-mail:
| |
Collapse
|