401
|
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
|
402
|
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
|
403
|
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
|
404
|
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]
|
405
|
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
|
406
|
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
|
407
|
|
408
|
Abstract
The obese asthma phenotype is an increasingly common encounter in our clinical practice. Epidemiological data indicate that obesity increases the prevalence and incidence of asthma, and evidence that obesity precedes the development of asthma raises the possibility of a causal association. Obese patients with asthma experience more symptoms and increased morbidity compared with non-obese asthma patients. Despite more than a decade of research into this association, the exact mechanisms that underlie the interaction of obesity with asthma remain unclear. It is unlikely that the asthma-obesity association is simply due to comorbidities such as obstructive sleep apnoea or gastroesophageal reflux disease. Although inflammatory pathways are purported to play a role, there is scant direct evidence in humans that systemic inflammation modulates the behaviour of the asthmatic airway or the expression of symptoms in the obese. The role of non-eosinophilic airway inflammation also requires further study. Obesity results in important changes to the mechanical properties of the respiratory system, and these obesity-related factors appear to exert an additive effect to the asthma-related changes seen in the airways. An understanding of the various physiological perturbations that might be contributing to symptoms in obese patients with asthma will allow for a more targeted and rational treatment approach for these patients.
Collapse
Affiliation(s)
- Claude S Farah
- The Woolcock Institute of Medical Research, Cooperative Research Centre for Asthma and Airways, Glebe, and The University of Sydney, Sydney, New South Wales, Australia.
| | | |
Collapse
|
409
|
DREHER MICHAEL, KABITZ HANSJOACHIM. Impact of obesity on exercise performance and pulmonary rehabilitation. Respirology 2012; 17:899-907. [DOI: 10.1111/j.1440-1843.2012.02151.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
410
|
BAHAMMAM AHMEDS, AL-JAWDER SUHAILAE. Managing acute respiratory decompensation in the morbidly obese. Respirology 2012; 17:759-71. [DOI: 10.1111/j.1440-1843.2011.02099.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
411
|
Bramley AM, Dasgupta S, Skarbinski J, Kamimoto L, Fry AM, Finelli L, Jain S. Intensive care unit patients with 2009 pandemic influenza A (H1N1pdm09) virus infection - United States, 2009. Influenza Other Respir Viruses 2012; 6:e134-42. [PMID: 22672249 DOI: 10.1111/j.1750-2659.2012.00385.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND The influenza A (H1N1pdm09) [pH1N1] virus resulted in intensive care unit (ICU) admissions, acute respiratory distress syndrome (ARDS), and death. OBJECTIVES To describe the characteristics of ICU patients with pH1N1 virus infection in the United States during the spring and fall of 2009 and to describe the factors associated with severe complications including ARDS and death. PATIENTS/METHODS Through two national case-series conducted during spring and fall of 2009, medical charts were reviewed on ICU patients with laboratory-confirmed pH1N1 infection by real-time reverse-transcriptase polymerase chain reaction. RESULTS The majority (77%) of 154 patients hospitalized in an ICU were <50 years of age, and 65% had at least one underlying medical condition. One hundred and twenty-eight (83%) patients received influenza antiviral agents; 29% received treatment ≤ 2 days after illness onset. Forty-eight (38%) patients developed ARDS and 37 (24%) died. Patients with ARDS were more likely to be morbidly obese (36% versus 19%, P=0.04) and patients who died were less likely to have asthma (11% versus 28%, P=0.05). Compared with patients who received treatment ≥ 6 days after illness onset, patients treated ≤ 2 days after illness onset were less likely to develop ARDS (17% versus 37%, P<0.01) or die (7% versus 35%, P<0.01). CONCLUSIONS Among patients hospitalized in an ICU with pH1N1 virus infection, ARDS was a common complication, and one-quarter of patients died. Patients with asthma had less severe outcomes. Early treatment with influenza antiviral agents was likely beneficial, especially when initiated ≤ 2 days after illness onset.
Collapse
Affiliation(s)
- Anna M Bramley
- Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
| | | | | | | | | | | | | | | |
Collapse
|
412
|
Franssen FME. Obesity, airflow limitation, and respiratory symptoms: does it take three to tango? PRIMARY CARE RESPIRATORY JOURNAL : JOURNAL OF THE GENERAL PRACTICE AIRWAYS GROUP 2012; 21:131-3. [PMID: 22596246 DOI: 10.4104/pcrj.2012.00040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
|
413
|
Guimarães C, Martins M, Moutinho dos Santos J. Função pulmonar em doentes obesos submetidos a cirurgia bariátrica. REVISTA PORTUGUESA DE PNEUMOLOGIA 2012; 18:115-9. [DOI: 10.1016/j.rppneu.2012.01.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 01/03/2012] [Indexed: 11/26/2022] Open
|
414
|
BOREL JEANCHRISTIAN, BOREL ANNELAURE, MONNERET DENIS, TAMISIER RENAUD, LEVY PATRICK, PEPIN JEANLOUIS. Obesity hypoventilation syndrome: From sleep-disordered breathing to systemic comorbidities and the need to offer combined treatment strategies. Respirology 2012; 17:601-10. [DOI: 10.1111/j.1440-1843.2011.02106.x] [Citation(s) in RCA: 50] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
|
415
|
Yamakoshi S, Ubara Y, Suwabe T, Hiramatsu R, Yamanouchi M, Hayami N, Sumida K, Hasegawa E, Hoshino J, Sawa N, Takaichi K, Kawabata M. Transcatheter renal artery embolization improves lung function in patients with autosomal dominant polycystic kidney disease on hemodialysis. Clin Exp Nephrol 2012; 16:773-8. [PMID: 22526485 DOI: 10.1007/s10157-012-0619-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2011] [Accepted: 02/23/2012] [Indexed: 12/22/2022]
Abstract
BACKGROUND Since 1996, transcatheter renal artery embolization (renal TAE) has been performed to reduce the volume of the kidneys in patients with autosomal dominant polycystic kidney disease (ADPKD) and complications of nephromegaly at our hospital. Respiratory dysfunction is often a serious problem in these patients before TAE. PATIENTS AND METHODS Between January 2006 and October 2008, renal TAE was performed and lung function testing [percent vital capacity (%VC) and percent forced expiratory volume in 1 s (%FEV(1.0))] was done by spirometry in 28 patients on maintenance hemodialysis who had respiratory symptoms. RESULTS Renal volume was 6,330.5 ± 3,126.5 cm(3) (range 1,771-12,761 cm(3)) before TAE, and decreased significantly to 2,892.2 ± 1,841.7 cm(3) (range 622-6,961 cm(3)) by 12 months after TAE (p = 0.0001). The percent decrease of renal volume at 12 months after TAE versus baseline was 45.6 ± 14.6% (range 6.6-67.3%). %VC showed a significant increase from 95.9 ± 14.8% (range 63-127%) before renal TAE to 100.1 ± 11.7% (range 78-120%) at 12 months after TAE (p < 0.01). %FEV(1.0) was also significantly increased from 87.9 ± 15.0% (range 55-110%) before renal TAE to 92.5 ± 14.4% (range 58.0-115.0%) at 12 months after TAE (p < 0.01). The changes of VC (ΔVC%) and FEV(1.0) (ΔFEV(1.0)%) both showed a significant positive correlation with the reduction of renal volume (Δ renal volume) (p = 0.001 and p = 0.004, respectively). CONCLUSION Since TAE not only led to a significant decrease of renal volume in ADPKD patients with nephromegaly, but also improved lung function (both %VC and %FEV(1.0)), pulmonary dysfunction should be recognized as one of the extrarenal complications of ADPKD.
Collapse
Affiliation(s)
- Shiho Yamakoshi
- Department of Pulmonary and Critical Care Medicine, Toranomon Hospital, Kajigaya, Kanagawa, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
416
|
Al Ghobain M. The effect of obesity on spirometry tests among healthy non-smoking adults. BMC Pulm Med 2012; 12:10. [PMID: 22436173 PMCID: PMC3337807 DOI: 10.1186/1471-2466-12-10] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2011] [Accepted: 03/21/2012] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION The effects of obesity on pulmonary functions have not been addressed previously among Saudi population. We aim to study the effects of obesity on spirometry tests among healthy non-smoking adults. METHODS A cross sectional study conducted among volunteers healthy non-smoking adults Subjects. We divided the subjects into two groups according to their BMI. The first group consisted of non-obese subjects with BMI of 18 to 24.9 kg/m2 and the second group consisted of obese subjects with BMI of 30 kg/m2 and above. Subjects underwent spirometry tests according to American thoracic society standards with measurement of the following values: the forced vital capacity (FVC), forced expiratory volume in one second (FEV1), peak expiratory flow rate (PEF) and forced mid-expiratory flow (FEF25-75). RESULTS The total subjects were 294 with a mean age of 32 years. There were 178 males and 116 females subjects. We found no significant differences in FEV1 (p value = 0.686), FVC (p value = 0.733), FEV1/FVC Ratio (p value = 0.197) and FEF25-75 (p value = 0.693) between the obese and non-obese subjects. However, there was significantly difference in PEF between the two groups (p value < 0.020). CONCLUSION Obesity does not have effect on the spirometry tests (except PEF) among health non-smoking adults. We recommend searching for alternative diagnosis in case of findings abnormal spirometry tests results among obese subjects.
Collapse
Affiliation(s)
- Mohammed Al Ghobain
- Department of Medicine, College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, P.O. Box 90068 11321, Saudi Arabia.
| |
Collapse
|
417
|
|
418
|
Isono S. Obesity and obstructive sleep apnoea: mechanisms for increased collapsibility of the passive pharyngeal airway. Respirology 2012; 17:32-42. [PMID: 22023094 DOI: 10.1111/j.1440-1843.2011.02093.x] [Citation(s) in RCA: 139] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Epidemiological evidence suggests there are significant links between obesity and obstructive sleep apnoea (OSA), with a particular emphasis on the importance of fat distribution in the development of OSA. In patients with OSA, the structure of the pharyngeal airway collapses. A collapsible tube within a rigid box collapses either due to decreased intraluminal pressure or increased external tissue pressure (i.e. reduction in transmural pressure), or due to reduction in the longitudinal tension of the tube. Accordingly, obesity should structurally increase the collapsibility of the pharyngeal airway due to excessive fat deposition at two distinct locations. In the pharyngeal airway region, excessive soft tissue for a given maxillomandibular enclosure size (upper airway anatomical imbalance) can increase tissue pressure surrounding the pharyngeal airway, thereby narrowing the airway. Even mild obesity may cause anatomical imbalance in individuals with a small maxilla and mandible. Lung volume reduction due to excessive central fat deposition may decrease longitudinal tracheal traction forces and pharyngeal wall tension, changing the 'tube law' in the pharyngeal airway (lung volume dependence of the upper airway). The lung volume dependence of pharyngeal airway patency appears to contribute more significantly to the development of OSA in morbidly obese, apnoeic patients. Neurostructural interactions required for stable breathing may be influenced by obesity-related hormones and cytokines. Accumulating evidence strongly supports these speculations, but further intensive research is needed.
Collapse
Affiliation(s)
- Shiroh Isono
- Department of Anesthesiology, Graduate School of Medicine, Chiba University, Chiba, Japan.
| |
Collapse
|
419
|
Lung physiology and obesity: anesthetic implications for thoracic procedures. Anesthesiol Res Pract 2012; 2012:154208. [PMID: 22611385 PMCID: PMC3353144 DOI: 10.1155/2012/154208] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2011] [Revised: 11/20/2011] [Accepted: 11/21/2011] [Indexed: 11/17/2022] Open
Abstract
Obesity is a worldwide health problem affecting 34% of the American population. As a result, more patients requiring anesthesia for thoracic surgery will be overweight or obese. Changes in static and dynamic respiratory mechanics, upper airway anatomy, as well as multiple preoperative comorbidities and altered drug metabolism, characterize obese patients and affect the anesthetic plan at multiple levels. During the preoperative evaluation, patients should be assessed to identify who is at risk for difficult ventilation and intubation, and postoperative complications. The analgesia plan should be executed starting in the preoperative area, to increase the success of extubation at the end of the case and prevent reintubation. Intraoperative ventilatory settings should be customized to the changes in respiratory mechanics for the specific patient and procedure, to minimize the risk of lung damage. Several non invasive ventilatory modalities are available to increase the success rate of extubation at the end of the case and to prevent reintubation. The goal of this review is to evaluate the physiological and anatomical changes associated with obesity and how they affect the multiple components of the anesthetic management for thoracic procedures.
Collapse
|
420
|
Grasso S, Terragni P, Birocco A, Urbino R, Del Sorbo L, Filippini C, Mascia L, Pesenti A, Zangrillo A, Gattinoni L, Ranieri VM. ECMO criteria for influenza A (H1N1)-associated ARDS: role of transpulmonary pressure. Intensive Care Med 2012; 38:395-403. [PMID: 22323077 DOI: 10.1007/s00134-012-2490-7] [Citation(s) in RCA: 140] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2011] [Accepted: 10/11/2011] [Indexed: 01/19/2023]
Abstract
PURPOSE To assess whether partitioning the elastance of the respiratory system (E (RS)) between lung (E (L)) and chest wall (E (CW)) elastance in order to target values of end-inspiratory transpulmonary pressure (PPLAT(L)) close to its upper physiological limit (25 cmH(2)O) may optimize oxygenation allowing conventional treatment in patients with influenza A (H1N1)-associated ARDS referred for extracorporeal membrane oxygenation (ECMO). METHODS Prospective data collection of patients with influenza A (H1N1)-associated ARDS referred for ECMO (October 2009-January 2010). Esophageal pressure was used to (a) partition respiratory mechanics between lung and chest wall, (b) titrate positive end-expiratory pressure (PEEP) to target the upper physiological limit of PPLAT(L) (25 cmH(2)O). RESULTS Fourteen patients were referred for ECMO. In seven patients PPLAT(L) was 27.2 ± 1.2 cmH(2)O; all these patients underwent ECMO. In the other seven patients, PPLAT(L) was 16.6 ± 2.9 cmH(2)O. Raising PEEP (from 17.9 ± 1.2 to 22.3 ± 1.4 cmH(2)O, P = 0.0001) to approach the upper physiological limit of transpulmonary pressure (PPLAT(L) = 25.3 ± 1.7 cm H(2)O) improved oxygenation index (from 37.4 ± 3.7 to 16.5 ± 1.4, P = 0.0001) allowing patients to be treated with conventional ventilation. CONCLUSIONS Abnormalities of chest wall mechanics may be present in some patients with influenza A (H1N1)-associated ARDS. These abnormalities may not be inferred from measurements of end-inspiratory plateau pressure of the respiratory system (PPLAT(RS)). In these patients, titrating PEEP to PPLAT(RS) may overestimate the incidence of hypoxemia refractory to conventional ventilation leading to inappropriate use of ECMO.
Collapse
Affiliation(s)
- Salvatore Grasso
- Dipartimento dell'Emergenza e Trapianti d'Organo, Sezione di Anestesiologia e Rianimazione, Università degli Studi Aldo Moro, Bari, Italy
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
421
|
Jung B, Azuelos I, Chanques G, Jaber S. How to improve preoxygenation before intubation in patients at risk? TRENDS IN ANAESTHESIA AND CRITICAL CARE 2012. [DOI: 10.1016/j.tacc.2011.09.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
422
|
Scott HA, Gibson PG, Garg ML, Pretto JJ, Morgan PJ, Callister R, Wood LG. Relationship between body composition, inflammation and lung function in overweight and obese asthma. Respir Res 2012; 13:10. [PMID: 22296721 PMCID: PMC3329414 DOI: 10.1186/1465-9921-13-10] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2011] [Accepted: 02/01/2012] [Indexed: 01/14/2023] Open
Abstract
Background The obese-asthma phenotype is not well defined. The aim of this study was to examine both mechanical and inflammatory influences, by comparing lung function with body composition and airway inflammation in overweight and obese asthma. Methods Overweight and obese (BMI 28-40 kg/m2) adults with asthma (n = 44) completed lung function assessment and underwent full-body dual energy x-ray absorptiometry. Venous blood samples and induced sputum were analysed for inflammatory markers. Results In females, android and thoracic fat tissue and total body lean tissue were inversely correlated with expiratory reserve volume (ERV). Conversely in males, fat tissue was not correlated with lung function, however there was a positive association between android and thoracic lean tissue and ERV. Lower body (gynoid and leg) lean tissue was positively associated with sputum %neutrophils in females, while leptin was positively associated with android and thoracic fat tissue in males. Conclusions This study suggests that both body composition and inflammation independently affect lung function, with distinct differences between males and females. Lean tissue exacerbates the obese-asthma phenotype in females and the mechanism responsible for this finding warrants further investigation.
Collapse
Affiliation(s)
- Hayley A Scott
- Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, Newcastle, NSW Australia
| | | | | | | | | | | | | |
Collapse
|
423
|
Kotloff RM, Heffner JE. Obesity and primary graft dysfunction: weighing the evidence. Am J Respir Crit Care Med 2012; 184:994-6. [PMID: 22045746 DOI: 10.1164/rccm.201108-1431ed] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
|
424
|
Yoshimura C, Oga T, Chin K, Takegami M, Takahashi KI, Sumi K, Nakamura T, Nakayama-Ashida Y, Minami I, Horita S, Oka Y, Wakamura T, Fukuhara S, Mishima M, Kadotani H. Relationships of decreased lung function with metabolic syndrome and obstructive sleep apnea in Japanese males. Intern Med 2012; 51:2291-7. [PMID: 22975537 DOI: 10.2169/internalmedicine.51.7427] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Decreased lung function as assessed by forced vital capacity (FVC) and forced expiratory volume in one second (FEV(1)) is shown to be associated with cardiovascular morbidity and mortality. Although the underlying mechanisms for this association remain unknown, metabolic syndrome and obstructive sleep apnea (OSA) may have a role. We analyzed the relationships between metabolic syndrome and OSA in a cross-sectional health survey of middle-aged male employees. METHODS In this secondary analysis, we re-analyzed the relationships of lung function determined by spirometry with metabolic syndrome and OSA based on the respiratory disturbance index (RDI) with a type 3 portable monitor. RESULTS We analyzed 273 subjects. Independent of age, body mass index (BMI) and smoking, quartiles for lower FVC and FEV(1) were associated with a higher risk of metabolic syndrome compared with quartiles for the highest FVC and FEV(1), respectively. A similar trend was observed regarding the risk associated with waist circumference, and in FVC cases, dyslipidemia. The risk of hyperglycemia was significantly higher in quartiles for the second lowest FVC and FEV(1) than in quartiles for the highest FVC and FEV(1), respectively. A significant trend for an increase in RDI was observed in accordance with quartiles for lower FVC, but not FEV(1). CONCLUSION There was a significant relationship between lung function impairment and metabolic syndrome through mainly abdominal obesity, partially through hyperglycemia, and also through dyslipidemia, but only with respect to restrictive lung function. Restrictive lung function was also related to OSA. This epidemiologic evidence may indicate underlying mechanisms between decreased lung function and cardiovascular risk.
Collapse
Affiliation(s)
- Chikara Yoshimura
- Department of Respiratory Care and Sleep Control Medicine, Graduate School of Medicine, Kyoto University, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
425
|
Tessier A, Zavorsky GS, Kim DJ, Carli F, Christou N, Mayo NE. Understanding the Determinants of Weight-Related Quality of Life among Bariatric Surgery Candidates. J Obes 2012; 2012:713426. [PMID: 22292114 PMCID: PMC3265129 DOI: 10.1155/2012/713426] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2011] [Accepted: 10/07/2011] [Indexed: 11/17/2022] Open
Abstract
Obesity and its relation to quality of life are multifaceted. The purpose of this paper was to contribute evidence to support a framework for understanding the impact of obesity on quality of life in 42 morbidly obese subjects considering a wide number of potential determinants. A model of weight-related quality of life (WRQL) was developed based on the Wilson-Cleary model, considering subjects' weight characteristics, arterial oxygen pressure (PaO(2)), walking capacity (6-minute walk test, 6MWT), health-related quality of life (HRQL; Physical and Mental Component Summaries of the SF-36 PCS/MCS), and WRQL. The model of WRQL was tested with linear regressions and a path analysis, which showed that as PaO(2) at rest increased 6MWT increased. 6MWT was positively associated with the PCS, which in turn was positively related to WRQL along with the MCS. The model showed good fit and explained 38% of the variance in WRQL.
Collapse
Affiliation(s)
- Annie Tessier
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Gerald S. Zavorsky
- Human Physiology Laboratory, Marywood University, Scranton, PA 18509, USA
- The Commonwealth Medical College, Scranton, PA 18509, USA
- *Gerald S. Zavorsky:
| | - Do Jun Kim
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
| | - Franco Carli
- Department of Anesthesia, Montreal General Hospital, McGill University Health Center, 1650 Cedar Avenue, Room D10-144, Montreal, QC, Canada H3G 1A4
| | - Nicolas Christou
- Department of Surgery, Bariatric Clinic, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Room S6.24, Montreal, QC, Canada H3A 1A1
| | - Nancy E. Mayo
- School of Physical and Occupational Therapy, McGill University Health Center, 3654 Promenade Sir William Osler, Montreal, QC, Canada H3G 1V5
- Division of Clinical Epidemiology, Royal Victoria Hospital, McGill University Health Center, 687 Pine Avenue West, Ross 4.29, Montreal, QC, Canada H3A 1A1
| |
Collapse
|
426
|
|
427
|
Marini JJ. Dynamic hyperinflation and auto-positive end-expiratory pressure: lessons learned over 30 years. Am J Respir Crit Care Med 2011; 184:756-62. [PMID: 21700908 DOI: 10.1164/rccm.201102-0226pp] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Auto-positive end-expiratory pressure (auto-PEEP; AP) and dynamic hyperinflation (DH) may affect hemodynamics, predispose to barotrauma, increase work of breathing, cause dyspnea, disrupt patient-ventilator synchrony, confuse monitoring of hemodynamics and respiratory system mechanics, and interfere with the effectiveness of pressure-regulated ventilation. Although basic knowledge regarding the clinical physiology and management of AP during mechanical ventilation has evolved impressively over the 30 years since DH and AP were first brought to clinical attention, novel and clinically relevant characteristics of this complex phenomenon continue to be described. This discussion reviews some of the more important aspects of AP that bear on the care of the ventilated patient with critical illness.
Collapse
Affiliation(s)
- John J Marini
- Pulmonary and Critical Care Medicine, University of Minnesota, St Paul, MN 55101-2595, USA.
| |
Collapse
|
428
|
Pekkarinen E, Vanninen E, Länsimies E, Kokkarinen J, Timonen KL. Relation between body composition, abdominal obesity, and lung function. Clin Physiol Funct Imaging 2011; 32:83-8. [PMID: 22296626 DOI: 10.1111/j.1475-097x.2011.01064.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- E Pekkarinen
- Department of Clinical Physiology, Nuclear Medicine and Neurophysiology, Diagnostic Imaging Centre, Kuopio University Hospital, P.O. Box 1777, Fin-70211 Kuopio, Finland.
| | | | | | | | | |
Collapse
|
429
|
Cross TJ, Sabapathy S, Beck KC, Morris NR, Johnson BD. The resistive and elastic work of breathing during exercise in patients with chronic heart failure. Eur Respir J 2011; 39:1449-57. [PMID: 22034652 DOI: 10.1183/09031936.00125011] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Patients with heart failure (HF) display numerous derangements in ventilatory function, which together serve to increase the work of breathing (W(b)) during exercise. However, the extent to which the resistive and elastic properties of the respiratory system contribute to the higher W(b) in these patients is unknown. We quantified the resistive and elastic W(b) in patients with stable HF (n = 9; New York Heart Association functional class I-II) and healthy control subjects (n = 9) at standardised levels of minute ventilation (V'(E)) during graded exercise. Dynamic lung compliance was systematically lower for a given level of V'(E) in HF patients than controls (p<0.05). HF patients displayed slightly higher levels of inspiratory elastic W(b) with greater amounts of ventilatory constraint and resistive W(b) than control subjects during exercise (p<0.05). Our data indicates that the higher W(b) in HF patients is primarily due to a greater resistive, rather than elastic, load to breathing. The greater resistive W(b) in these patients probably reflects an increased hysteresivity of the airways and lung tissues. The marginally higher inspiratory elastic W(b) observed in HF patients appears related to a combined decrease in the compliances of the lungs and chest wall. The clinical and physiological implications of our findings are discussed.
Collapse
Affiliation(s)
- Troy J Cross
- Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | |
Collapse
|
430
|
Dominelli PB, Sheel AW, Foster GE. Effect of carrying a weighted backpack on lung mechanics during treadmill walking in healthy men. Eur J Appl Physiol 2011; 112:2001-12. [PMID: 21947409 DOI: 10.1007/s00421-011-2177-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2011] [Accepted: 09/09/2011] [Indexed: 11/30/2022]
Abstract
Weighted backpacks are used extensively in recreational and occupational settings, yet their effects on lung mechanics during acute exercise is poorly understood. The purpose of this study was to determine the effects of different backpack weights on lung mechanics and breathing patterns during treadmill walking. Subjects (n = 7, age = 28 ± 6 years), completed two 2.5-min exercise stages for each backpack condition [no backpack (NP), an un-weighted backpack (NW) or a backpack weighing 15, 25 or 35 kg]. A maximal expiratory flow volume curve was generated for each backpack condition and an oesophageal balloon catheter was used to estimate pleural pressure. The 15, 25 and 35 kg backpacks caused a 3, 5 and 8% (P < 0.05) reduction in forced vital capacity compared with the NP condition, respectively. For the same exercise stage, the power of breathing (POB) requirement was higher in the 35 kg backpack compared to NP (32 ± 4.3 vs. 88 ± 9.0 J min(-1), P < 0.05; respectively). Independent of changes in minute ventilation, end-expiratory lung volume decreased as backpack weight increased. As backpack weight increased, there was a concomitant decline in calculated maximal ventilation, a rise in minute ventilation, and a resultant greater utilization of maximal available ventilation. In conclusion, wearing a weighted backpack during an acute bout of exercise altered operational lung volumes; however, adaptive changes in breathing mechanics may have minimized changes in the required POB such that at an iso-ventilation, wearing a backpack weighing up to 35 kg does not increase the POB requirement.
Collapse
Affiliation(s)
- Paolo B Dominelli
- School of Kinesiology, The University of British Columbia, Vancouver, BC, Canada.
| | | | | |
Collapse
|
431
|
Watson RA, Pride NB, Thomas EL, Ind PW, Bell JD. Relation between trunk fat volume and reduction of total lung capacity in obese men. J Appl Physiol (1985) 2011; 112:118-26. [PMID: 21940844 DOI: 10.1152/japplphysiol.00217.2011] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Reduction in total lung capacity (TLC) in obese men is associated with restricted expansion of the thoracic cavity at full inflation. We hypothesized that thoracic expansion was reduced by the load imposed by increased total trunk fat volume or its distribution. Using MRI, we measured internal and subcutaneous trunk fat and total abdominal and thoracic volumes at full inflation in 14 obese men [mean age: 52.4 yr, body mass index (BMI): 38.8 (range: 36-44) kg/m(2)] and 7 control men [mean age: 50.1 yr, BMI: 25.0 (range: 22-27.5) kg/m(2)]. TLC was measured by multibreath helium dilution and was restricted (<80% of the predicted value) in six obese men (the OR subgroup). All measurements were made with subjects in the supine position. Mean total trunk fat volume was 16.65 (range: 12.6-21.8) liters in obese men and 6.98 (range: 3.0-10.8) liters in control men. Anthropometry and mean total trunk fat volumes were similar in OR men and obese men without restriction (the ON subgroup). Mean total intraabdominal volume was 9.41 liters in OR men and 11.15 liters in ON men. In obese men, reduced thoracic expansion at full inflation and restriction of TLC were not inversely related to a large volume of 1) intra-abdominal or total abdominal fat, 2) subcutaneous fat volume around the thorax, or 3) total trunk fat volume. In addition, trunk fat volumes in obese men were not inversely related to gas volume or estimated intrathoracic volume at supine functional residual capacity. In conclusion, this study failed to support the hypotheses that restriction of TLC or impaired expansion of the thorax at full inflation in middle-aged obese men was simply a consequence of a large abdominal volume or total trunk fat volume or its distribution.
Collapse
Affiliation(s)
- R A Watson
- Faculty of Medicine, National Heart and Lung Institute, Imperial College, Hammersmith Campus, London, UK
| | | | | | | | | |
Collapse
|
432
|
Skloot G, Schechter C, Desai A, Togias A. Impaired response to deep inspiration in obesity. J Appl Physiol (1985) 2011; 111:726-34. [PMID: 21700888 PMCID: PMC3174789 DOI: 10.1152/japplphysiol.01155.2010] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2010] [Accepted: 06/22/2011] [Indexed: 11/22/2022] Open
Abstract
Deep inspirations modulate airway caliber and airway closure and their effects are impaired in asthma. The association between asthma and obesity raises the question whether the deep inspiration (DI) effect is also impaired in the latter condition. We assessed the DI effects in obese and nonobese nonasthmatics. Thirty-six subjects (17 obese, 19 nonobese) underwent routine methacholine (Mch) challenge and 30 of them also had a modified bronchoprovocation in the absence of DIs. Lung function was monitored with spirometry and forced oscillation (FO) [resistance (R) at 5 Hz (R5), at 20 Hz (R20), R5-R20 and the integrated area of low-frequency reactance (AX)]. The response to Mch, assessed with area under the dose-response curves (AUC), was consistently greater in the routine challenge in the obese (mean ± SE, obese vs. nonobese AUC: R5: 15.7 ± 2.3 vs. 2.4 ± 2.0, P < 0.0005; R20: 5.6 ± 1.4 vs. 1.4 ± 1.2, P = 0.027; R5-R20: 10.2 ± 1.6 vs. 0.9 ± 0.1.4, P < 0.0005; AX: 115.6 ± 22.0 vs. 1.5 ± 18.9, P < 0.0005), but differences between groups in the modified challenge were smaller, indicating reduced DI effects in obesity. Given that DI has bronchodilatory and bronchoprotective effects, we further assessed these components separately. In the obese subjects, DI prior to Mch enhanced Mch-induced bronchoconstriction, but DI after Mch resulted in bronchodilation that was of similar magnitude as in the nonobese. We conclude that obesity is characterized by increased Mch responsiveness, predominantly of the small airways, due to a DI effect that renders the airways more sensitive to the stimulus.
Collapse
Affiliation(s)
- Gwen Skloot
- Division of Pulmonary, Critical Care & Sleep Medicine, Mount Sinai Medical Center, One Gustave L. Levy Place, Box #1232, New York, NY 10029, USA.
| | | | | | | |
Collapse
|
433
|
Salvator H, Devillier P, Rivaud E, Catherinot E, Honderlick P, Couderc LJ. [Obesity, poor prognostic factor in pandemic influenza A (H1N1) 2009: the role of adipokines in the modulation of respiratory defenses]. REVUE DE PNEUMOLOGIE CLINIQUE 2011; 67:244-249. [PMID: 21920285 DOI: 10.1016/j.pneumo.2011.01.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2011] [Accepted: 01/20/2011] [Indexed: 05/31/2023]
Abstract
Pandemic influenza A (H1N1), which occurred during 2009, revealed some unexpected epidemiologic characteristics, notably the high number of obese subjects among the severe cases of influenza. Generally, obesity seems to be associated with a weakness when it comes to respiratory infections. This susceptibility may be the result of a concurrence of mechanical and hormonal factors due to the excess weight. Obesity leads to changes in the ventilatory mechanics and an increase in the metabolic load during exercise. It is associated with immune system changes. Adipokines, cytokines produced by adipocytes, including leptin, play a central role by modulating the activity of all the cells of the immune system. Finally, obesity is associated with an increased risk of thrombosis, which has an adverse effect on the prognosis of infections. All of these observations can explain that obesity has been a risk factor in serious cases of influenza.
Collapse
Affiliation(s)
- H Salvator
- Service dePneumologie, Hôpital Foch, 40, rue Worth, 92150 Suresnes, France.
| | | | | | | | | | | |
Collapse
|
434
|
Kalhoff H, Breidenbach R, Smith HJ, Marek W. Impulse oscillometry in preschool children and association with body mass index. Respirology 2011; 16:174-9. [PMID: 21114710 DOI: 10.1111/j.1440-1843.2010.01906.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND AND OBJECTIVE The use of the impulse oscillometry system (IOS) allows differentiated lung function testing with a minimum of cooperation at normal tidal breathing. The aim of this cross-sectional study was to assess the association of body mass (overweight and obese) with oscillometric parameters in preschool children. METHODS A preschool medical check of 518 children (age 6.01 ± 0.25 years) included IOS recordings of airway resistance and lung reactance (MasterScreen IOS, CareFusion, Höchberg, Germany). Measured values of respiratory resistance (R5) and reactance (X5) at 5 Hz were correlated with BMI. In addition, data were compared with recently published reference equations. RESULTS In this young age group of 241 boys and 277 girls there was no significant association between oscillometric parameters and BMI. When compared with current IOS reference values of healthy subjects the relationship of R5 (109 ± 25%) and X5 (105.5 ± 35%) suggested mildly elevated peripheral resistance in this unselected group of preschool children. CONCLUSIONS IOS is ideally suited to obtain measurements of respiratory function in preschool children. At the age of 6 years, standard oscillometric values do not indicate impaired respiratory function associated with increased BMI.
Collapse
|
435
|
Mokhlesi B, Tulaimat A, Parthasarathy S. Oxygen for obesity hypoventilation syndrome: a double-edged sword? Chest 2011; 139:975-977. [PMID: 21540211 DOI: 10.1378/chest.10-2858] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Affiliation(s)
- Babak Mokhlesi
- Section of Pulmonary and Critical Care Medicine, Sleep Disorders Center, The University of Chicago Pritzker School of Medicine; the Division of Pulmonary and Critical Care Medicine, Sleep Laboratory, John H. Stroger Jr Hospital of Cook County, Chicago, IL.
| | - Aiman Tulaimat
- Section of Pulmonary and Critical Care Medicine, Sleep Disorders Center, The University of Chicago Pritzker School of Medicine; the Division of Pulmonary and Critical Care Medicine, Sleep Laboratory, John H. Stroger Jr Hospital of Cook County, Chicago, IL
| | - Sairam Parthasarathy
- Southern Arizona Veterans Administration Healthcare System, University of Arizona, Tucson, AZ
| |
Collapse
|
436
|
Aihara K, Oga T, Harada Y, Chihara Y, Handa T, Tanizawa K, Watanabe K, Hitomi T, Tsuboi T, Mishima M, Chin K. Analysis of anatomical and functional determinants of obstructive sleep apnea. Sleep Breath 2011; 16:473-81. [PMID: 21573913 DOI: 10.1007/s11325-011-0528-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2010] [Revised: 04/07/2011] [Accepted: 05/04/2011] [Indexed: 12/16/2022]
Abstract
PURPOSE Craniofacial abnormalities have an important role in the occurrence of obstructive sleep apnea (OSA) and may be particularly significant in Asian patients, although obesity and functional abnormalities such as reduced lung volume and increased airway resistance also may be important. We conducted simultaneous analyses of their interrelationships to evaluate the relative contributions of obesity, craniofacial structure, pulmonary function, and airway resistance to the severity of Japanese OSA because there are little data in this area. METHODS A cross-sectional observational study was performed on 134 consecutive Japanese male patients. A sleep study, lateral cephalometry, pulmonary function tests, and impulse oscillometry (IOS) were performed on all patients. RESULTS Age, body mass index (BMI), position of the hyoid bone, and proximal airway resistance on IOS (R20) were significantly related to the apnea/hypopnea index (AHI) (p < 0.05) in multiple regression analysis. Subgroup analysis showed that, for moderate-to-severe OSA (AHI ≥ 15 events/h), neck circumference and R20 were predominantly related to AHI, whereas for non-to-mild OSA (AHI < 15 events/h), age and expiratory reserve volume were the predominant determinants. In obese subjects (BMI ≥ 25 kg/m(2)), alveolar-arterial oxygen tension difference, position of the hyoid bone, and R20 were significantly associated with AHI, whereas age alone was a significant factor in nonobese subjects (BMI < 25 kg/m(2)). CONCLUSIONS Aside from age and obesity, anatomical and functional abnormalities are significantly related to the severity of Japanese OSA. Predominant determinants of AHI differed depending on the severity of OSA or the magnitude of obesity.
Collapse
Affiliation(s)
- Kensaku Aihara
- Department of Respiratory Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
437
|
Bautista J, Ehsan M, Normandin E, Zuwallack R, Lahiri B. Physiologic responses during the six minute walk test in obese and non-obese COPD patients. Respir Med 2011; 105:1189-94. [PMID: 21414763 DOI: 10.1016/j.rmed.2011.02.019] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Revised: 02/10/2011] [Accepted: 02/22/2011] [Indexed: 10/18/2022]
Abstract
Although obesity is a common co-morbid condition in COPD, relatively little is known how it may affect functional exercise capacity. Accordingly, we compared physiologic responses during a 6 min walk test in 10 obese and 10 non-obese COPD patients matched by gender, age, and spirometric severity category. Patients first exercised on a treadmill to determine maximal exercise responses, then following a rest period they completed a 6 min walk test. Breath by-breath analyses of expired air via a facemask was obtained using a portable, battery operated device. Oxygen consumption (VO(2)), carbon dioxide production (VCO(2)), tidal volume (VT), respiratory rate (RR), minute ventilation (VE), and inspiratory capacity (IC) were compared. The mean FEV1 in the obese and non-obese groups was 52 ± 13 and 58 ± 18 percent of predicted, respectively, and the BMI of the obese patients was 37 ± 02 kg/m(2). Obese patients had shorter 6 min walk distances than non-obese patients (247 ± 73 vs 348 ± 51 m, respectively, p = 0.003), but walk-work, defined as 6 min walk distance × weight (in kg), was not different. There were no significant between-group differences in any exercise variable measured during the 6 min walk test. In both groups, VO(2) and VE increased linearly over the first 2-3 min, then plateaued at approximately 80% of maximum. Although 6 min walk distance is shorter in obese COPD patients, their physiologic responses are similar to those of non-obese patients.
Collapse
Affiliation(s)
- Jennifer Bautista
- Section of Pulmonary and Critical Care Medicine, St. Francis Hospital & Medical Center, Hartford, CT 06105, USA
| | | | | | | | | |
Collapse
|
438
|
Gulli G, Miselli V. BPCO, obesità, sindrome metabolica e diabete. ITALIAN JOURNAL OF MEDICINE 2011. [DOI: 10.1016/j.itjm.2011.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
439
|
Raviv S, Dixon AE, Kalhan R, Shade D, Smith LJ. Effect of obesity on asthma phenotype is dependent upon asthma severity. J Asthma 2010; 48:98-104. [PMID: 21091180 DOI: 10.3109/02770903.2010.534220] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND We recently reported that obese and non-obese patients with asthma have similar airflow limitation and bronchodilator responsiveness, but obese patients have more symptoms overall. There is limited information on the effect of obesity on asthmatics of varying severity measured by objective physiological parameters. Understanding how obesity affects asthmatics of differing severity can provide insights into the pathogenesis of asthma in the obese and a rationale for the therapeutic approach to such patients. METHODS Participants with asthma from two American Lung Association--Asthma Clinical Research Center (ALA-ACRC) studies were grouped by tertiles of airflow obstruction (forced expiratory volume in one second (FEV(1)%) predicted, FEV(1)/forced vital capacity (FVC)) and methacholine reactivity (PC(20)FEV(1)). Within each tertile, we examined the independent effect of body mass index (BMI), divided into normal weight, overweight, and obese categories, on lung function, airway reactivity, and symptoms. RESULTS Overall, both FEV(1) and FVC decreased and symptoms worsened with increasing BMI; airway reactivity was unchanged. When stratified by the degree of airflow obstruction, higher BMI was not associated with greater airway reactivity to methacholine. Higher BMI was associated with more asthma symptoms only in the least obstructed FEV(1)/FVC tertile. When stratified by degree of airway reactivity, BMI was inversely associated with FVC in all PC(20)FEV(1) tertiles. BMI was directly associated with asthma symptoms only in those with the least airway reactivity. CONCLUSIONS Obesity does not influence airway reactivity in patients with asthma and it is associated with more symptoms only in those with less severe disease.
Collapse
Affiliation(s)
- Stacy Raviv
- Department of Pulmonary and Critical Care Medicine, Northshore University Health System, Evanston, IL, USA
| | | | | | | | | |
Collapse
|
440
|
Abstract
PURPOSE OF REVIEW Obese individuals have impaired respiratory function relative to their normal-weight counterparts. Despite these negative effects, obesity is paradoxically associated with better survival in individuals with chronic obstructive pulmonary disease (COPD). The purpose of this review is to describe this 'obesity paradox', to discuss the effects of obesity on respiratory function, and to speculate as to whether obesity-related alterations in respiratory mechanics can influence the natural history of COPD. RECENT FINDINGS Given the known negative effects of obesity on respiratory physiology, it is reasonable to predict that obese COPD patients would be more likely to experience greater dyspnea and exercise intolerance relative to COPD patients of normal weight. However, recent evidence suggests that obese COPD patients have similar or better dyspnea scores during exercise and do not have diminished exercise capacity. These observations may be attributable to the fact that obese COPD patients have reduced operating lung volumes and higher inspiratory capacity to total lung capacity ratios than their lean COPD counterparts. SUMMARY Obese patients with COPD do not appear to be at a disadvantage during exercise relative to lean COPD patients. Obesity may be associated with improved survival in COPD but specific mechanisms for this paradox remain to be elucidated.
Collapse
Affiliation(s)
- Jordan A Guenette
- Respiratory Investigation Unit, Department of Medicine, Queen's University, Kingston General Hospital, Kingston, Ontario, Canada
| | | | | |
Collapse
|
441
|
|
442
|
Pinto Pereira LM, Seemungal TA. Comorbid disease in asthma: the importance of diagnosis. Expert Rev Respir Med 2010; 4:271-4. [PMID: 20524908 DOI: 10.1586/ers.10.31] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
|
443
|
Prachand VN, Alverdy JC. Gastroesophageal reflux disease and severe obesity: Fundoplication or bariatric surgery? World J Gastroenterol 2010; 16:3757-61. [PMID: 20698037 PMCID: PMC2921086 DOI: 10.3748/wjg.v16.i30.3757] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Increases in the prevalence of obesity and gastroesophageal reflux disease (GERD) have paralleled one another over the past decade, which suggests the possibility of a linkage between these two processes. In both instances, surgical therapy is recognized as the most effective treatment for severe, refractory disease. Current surgical therapies for severe obesity include (in descending frequency) Roux-en-Y gastric bypass, adjustable gastric banding, sleeve gastrectomy, and biliopancreatic diversion with duodenal switch, while fundoplication remains the mainstay for the treatment of severe GERD. In several large series, however, the outcomes and durability of fundoplication in the setting of severe obesity are not as good as those in patients who are not severely obese. As such, bariatric surgery has been suggested as a potential alternative treatment for these patients. This article reviews current concepts in the putative pathophysiological mechanisms by which obesity contributes to gastroesophageal reflux and their implications with regards to surgical therapy for GERD in the setting of severe obesity.
Collapse
|
444
|
Sato K, Kawamura T, Yamagiwa S. The “Senobi” breathing exercise is recommended as first line treatment for obesity. Biomed Res 2010; 31:259-62. [DOI: 10.2220/biomedres.31.259] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|