Central obesity and other factors associated with uncontrolled asthma in women

Assessment of Behavioral Risk Factors in Chronic Obstructive Airway Diseases of the Lung Associated with Metabolic Syndrome

BACKGROUND

Diet and lifestyle play important roles in preventing and improving chronic diseases, and evaluating behavioral risk factors in these pathologies allows for efficient management.

METHODS

A clinical study by screening biochemical parameters and pulmonary function was carried out to evaluate behavioral risk factors in obstructive pulmonary disease associated with metabolic syndrome.

RESULTS

Of the total of 70 patients included in the clinical study, 46 were men and 24 were women (χ2 = 3.9, p = 0.168). Forty-eight patients presented at least three met risk criteria associated with the metabolic syndrome (19 women and 29 men). Regarding the assessment of lung function, only 7 of the patients presented normal spirometry values (χ2 = 75.28, p < 0.001), and the other 63 patients presented with ventilatory dysfunction; most (over 80%) declared that they were smokers or had smoked in the past (χ2 = 5.185, p = 0.075). In terms of body weight, 45 of the patients are overweight or obese, most of them declaring that they do not consume enough vegetable products, they consume large amounts of foods of animal origin (meat, milk, eggs) but also super processed foods (food products type of junk food), do not hydrate properly, and are predominantly sedentary people (54 of the patients do no physical activity at all; χ2 = 2.12, p = 0.713).

CONCLUSION

From the statistical processing of the data, it is noted that insufficient hydration, low consumption of vegetables, increased consumption of hyper-caloric food products rich in additives, sedentary lifestyle, and smoking are the main disruptive behavioral factors that worsen the health status in lung disease associated with the metabolic syndrome. An important conclusion emerging from the study is that the imbalances that aggravate obstructive lung diseases are generated by unhealthy food and an unbalanced lifestyle.

The Relationship Between General and Abdominal Obesity, Nutrition and Respiratory Functions in Adult Asthmatics

Objective: Although obesity is known to have adverse effects on asthma, it is not fully known whether general or abdominal obesity affects asthma symptoms more. In this study, the effects of diet and general/abdominal obesity on respiratory functions were evaluated.Methods: A total of 204 adult asthmatic individuals participated in the study. Anthropometric measurements, respiratory functions, asthma control test (ACT) scores, and 24-hour food consumption were recorded. The results were compared according to body mass index (BMI), waist circumference (WC), and waist-hip ratio (WHR) classification.Results: FEV₁, FVC, MEF_25-75, MEF₅₀, and MEF₂₅ decreased with the increase in BMI, WC, and WHR. FEV₁ showed a negative linear relationship with BMI, WC and WHR and these results were more significant in WC and WHR than BMI. Similarly, the ACT score also showed a negative correlation with BMI (r = -0.372; p = 0.023), WC (r = -0.402; p = 0.001) and WHR (r = -0.387; p = 0.011), and the results were more significant in WC and WHR than BMI. Individuals whose WC (OR: 2.170 CI (1.325-3.182)) and WHR (OR: 2.119 CI (1.246-3.338)) were at risk had higher odds of uncontrolled asthma than those with normal WC and WHR. Each 100-kcal increase in total energy consumption increased the odds of uncontrolled asthma (OR: 1.125 CI (1.086-2.217)) (p < 0.05).Conclusions: The effects of WC and WHR, which are indicators of abdominal obesity, on respiratory functions and ACT score were found to be higher than BMI. Obese individuals should be referred to diet clinics to improve their asthma symptoms.

Association between sleep quality and central obesity among southern Chinese reproductive-aged women

BACKGROUND

The connections between sleep quality and central obesity among reproductive-aged women are not clear. The study aimed to explore the association between sleep quality and central obesity among Chinese reproductive-aged women and identify the independent contributions of sociodemographic characteristics, health-related factors, and sleep quality to central obesity.

METHODS

In this cross-sectional survey, the minimal sample sizes were 2404 subjects; 2449 Chinese women aged 18-49 participated in this study. Sleep quality was assessed by the Chinese version of the Pittsburgh Sleep Quality Index (PSQI). Central obesity as the outcome of interest was a binary variable; women were categorized as with versus without central obesity measured by waist circumference (WC). The independent contribution of sociodemographic characteristics (Cluster 1), health-related variables (Cluster 2), and sleep quality (Cluster 3) to central obesity was derived from the corresponding R² change (individual R² change/total R² × 100%), using clustered multiple logistic regression analyses.

RESULTS

The risk of central obesity increased significantly with poor sleep quality (assessed by global PSQI score) [adjusted odds ratio (OR) = 2.20 per SD increase; 95% confidence interval (CI) = 1.28-3.78; P = 0.004], increased sleep disturbance score (adjusted OR = 1.11 per SD increase; 95% CI = 1.01-1.22; P = 0.042) and decreased subjective sleep quality score (adjusted OR = 0.81 per SD increase; 95% CI = 0.73-0.90; P < 0.001). The independent contribution of sleep quality was 9.9%, less than those of sociodemographic (73.3%) and health-related (16.8%) variables. Among complaints related to sleep disturbance, the inability to breathe comfortably, and having bad dreams showed significant associations with central obesity.

CONCLUSIONS

There exists some degree of correlation between sleep quality and central obesity among Chinese reproductive-aged women. These findings underscore the need for future public health guidelines to formulate some detailed strategies to improve sleep quality, such as preventing and intervening risk factors that influence sleep quality and suggesting optimal sleep duration, which might effectively reduce the incidence of central obesity in this population group.

Predictors of Asthma Control and Exacerbations: A Real-World Study

BACKGROUND

Achieving optimal asthma control and minimizing the risk of exacerbation are the main goals of asthma treatment.

OBJECTIVE

This study aimed to assess the predictors of poor asthma control and asthma exacerbations within a population of moderate to severe asthmatic patients treated in a tertiary-care center.

METHODS

We conducted a cohort study assessing 738 patients enrolled in the Quebec registry in respiratory health (RESP) with a diagnosis of asthma confirmed by a respirologist and treated in a tertiary care center from April 2010 to March 2016. Sociodemographic and clinical data, including Asthma Control Questionnaire score, were collected at enrollment in the registry (ie, cohort entry) and patients were followed for a 2-year period thereafter. The information regarding exacerbations that occurred during follow-up was collected in administrative databases (Régie d l'assurance médicale du Québec [RAMQ], Maintenance et exploitation des données pour l'étude de la clientèle hospitalière [MED-ECHO], and medication data registry [reMed]).

RESULTS

We assessed 738 subjects (64% women). Psychological distress (odds ratio [OR] 1.91; 95% confidence interval [95% CI] 1.21-3.02), smoking (OR 3.72; 95% CI 1.72-8.05]), and poor lung function, forced expiratory volume in 1 second less than 50% (OR 4.1; 95% CI 1.48-11.34]) appeared as significant factors associated with uncontrolled asthma. Occurrence of previous asthma exacerbations (hazard ratio [HR] 6.25; 95% CI 4.01-9.75]), poor asthma control (HR 1.60; 95% CI 1.07-2.38]), forced expiratory volume in 1 second between 50% and 80% (HR 2.25; 95% CI 1.58-3.34]), and older age (HR 2.26; 95% CI 1.37-3.74]) were associated with asthma exacerbations. Adherence to asthma treatment was very low in patients with (44.4% ± 34.4%) and without asthma exacerbations (37.5% ± 33.0%).

CONCLUSIONS

Psychological distress and current smoking are modifiable factors that need to be addressed in tailored behavioral interventions to improve asthma control. Asthma exacerbations are mostly associated with the intrinsic severity of the disease.

Possible risk factors for poor asthma control assessed in a cross-sectional population-based study from Telemark, Norway

This cross-sectional study of the general population of Telemark County, Norway, aimed to identify risk factors associated with poor asthma control as defined by the Asthma Control Test (ACT), and to determine the proportions of patients with poorly controlled asthma who had undergone spirometry, used asthma medication, or been examined by a pulmonary physician. In 2014–2015, the study recruited 326 subjects aged 16–50 years who had self-reported physician-diagnosed asthma and presence of respiratory symptoms during the previous 12 months. The clinical outcome measures were body mass index (BMI), forced vital capacity (FVC) and forced expiratory volume in one second (FEV₁), fractional exhaled nitric oxide (FeNO), immunoglobulin E (IgE) in serum and serum C-reactive protein (CRP). An ACT score ≤ 19 was defined as poorly controlled asthma. Overall, 113 subjects (35%) reported poor asthma control. The odds ratios (ORs) and 95% confidence intervals (CIs) for factors associated with poorly controlled asthma were: self-reported occupational exposure to vapor, gas, dust, or fumes during the previous 12 months (OR 2.0; 95% CI 1.1–3.6), body mass index ≥ 30 kg/m² (OR 2.2; 95% CI 1.2–4.1), female sex (OR 2.6; 95% CI 1.5–4.7), current smoking (OR 2.8; 95% CI 1.5–5.3), and past smoking (OR 2.3; 95% CI 1.3–4.0). Poor asthma control was also associated with reduced FEV₁ after bronchodilation (β –3.6; 95% CI –7.0 to –0.2). Moreover, 13% of the participants with poor asthma control reported no use of asthma medication, 51% had not been assessed by a pulmonary physician, and 20% had never undergone spirometry. Because these data are cross-sectional, further studies assessing possible risk factors in general and objectively measured occupational exposure in particular are needed. However, our results suggest that there is room for improvement with regards to use of spirometry and pulmonary physician referrals when a patient’s asthma is inadequately controlled.

Association between abdominal obesity and asthma: a meta-analysis

Background

Studies evaluating the association between abdominal obesity and asthma yielded conflict results. Whether abdominal obesity is positively associated with asthma remains unclear.

Objective

To quantitatively determine the association between abdominal obesity and asthma.

Methods

Databases including PubMed, Web of Science, China National Knowledge Infrastructure, China Biology Medicine disc, Chinese Scientific and Technological Journal Database and Wanfang Data were searched up to February 2018 to collect all relevant studies. Reference lists of related articles were also checked. After study selection and data extraction, meta-analysis was conducted to calculate the pooled odds ratio (OR) and corresponding 95% confidence interval (CI). Subgroup analyses by study design and age groups of participants were further performed. Publication bias was assessed via Begg’s rank correlation and Egger’s linear regression methods.

Results

A total of 13 studies were included in the final meta-analysis, including 2 case–control studies, 6 cohort studies, and 5 cross-sectional studies. Our meta-analysis observed a positive association between abdominal obesity and asthma (OR = 1.47, 95% CI 1.35–1.59). No evidence of heterogeneity (I² = 10.7%) or publication bias (Begg’s test P = 0.200, Egger’s test P = 0.146) was found. Subgroup analyses by study design and age groups of participants obtained consistently positive results across subgroups. Moreover, our meta-analysis observed similar results when considering this association separately in males and females (Males: OR = 1.37, 95% CI 1.18–1.58; Females: OR = 1.39, 95% CI 1.22–1.58). In addition, the association between abdominal overweight and asthma was further explored in this meta-analysis and the pooled OR and 95% CI was 1.13 (1.03, 1.24), indicating that there is a dose–response relationship between abdominal weight status and asthma.

Conclusions

Our meta-analysis shows a positive association between abdominal obesity and asthma. Moreover, this association is similar in males and females. In addition, our meta-analysis indicates that there is a dose–response relationship between abdominal weight status and asthma. Therefore, addressing abdominal obesity issue is of great importance. More studies are needed in the future to clarify the association between abdominal obesity and asthma.

Interactive effects of adiposity and insulin resistance on the impaired lung function in asthmatic adults: cross-sectional analysis of NHANES data

BACKGROUND

Obesity is considered a risk factor for both asthma and insulin resistance in adults. Insulin resistance (IR) also influences pulmonary function in the non-obese population.

AIM

To investigate the modifying effect of insulin resistance on the predictive role of anthropometric measures in the estimation of impaired lung function among asthmatic adults.

SUBJECTS AND METHODS

A cross-sectional study of 1276 adults extracted from the NHANES 2009-2012 database was performed. Adjusted multiple linear regression was conducted to analyse the contributory role of obesity and IR in predicting lung function among asthmatic adults.

RESULTS

BMI, waist circumference (WC) and waist-to-height ratio (WHtR) showed significantly negative correlations with FVC (r=-0.24, -0.18, -0.39, respectively; p < 0.001), FEV1(r=-0.24, -0.21, -0.40, respectively; p < 0.001) and FEF 25-75% (r=-0.15, -0.18, -0.27, respectively; p < 0.001). Even after adjustment for the covariates (age, gender, smoking history and standing height), BMI and HOMA-IR had significant relationships with FVC (β= -10.3; p < 0.01 and β= -16.0; p < 0.05) and FEV1 (β= -8.7; p < 0.01 and β= -11.7; p < 0.05). BMI could significantly predict the decreased FVC (β= -13.7; p < 0.01) and FEV1 (β= -10.7; p < 0.01) only in the insulin resistant asthmatics.

CONCLUSION

WHtR and IR predict impaired lung function in overweight/obese asthmatic adults independently. IR also modifies the association between excessive adiposity and respiratory function in asthmatic adults.

Obesity and asthma: clinical and laboratory characterization of a common combination

OBJECTIVE

To evaluate the relationship between obesity and asthma.

METHODS

This was a preliminary cross-sectional analysis involving 925 subjects with mild-to-moderate or severe asthma evaluated between 2013 and 2015. Obesity was defined on the basis of body mass index (BMI) and abdominal circumference. We collected clinical, laboratory, and anthropometric parameters, as well as pulmonary function test results and data regarding comorbidities. The subjects also completed asthma control and quality of life questionnaires.

RESULTS

Obese individuals had a significantly higher number of neutrophils in peripheral blood than did nonobese individuals (p = 0.01). Among the obese individuals, 163 (61%) had positive skin-prick test results, as did 69% and 71% of the individuals classified as being overweight or normal weight, respectively. Obese individuals showed lower spirometric values than did nonobese individuals, and 32% of the obese individuals had uncontrolled asthma, a significantly higher proportion than that found in the other groups (p = 0.02).

CONCLUSIONS

Obese individuals with asthma seem to present with poorer asthma control and lower pulmonary function values than do nonobese individuals. The proportion of subjects with nonatopic asthma was higher in the obese group. Our results suggest that obese individuals with asthma show a distinct inflammatory pattern and are more likely to present with difficult-to-control asthma than are nonobese individuals.

Visceral adiposity is associated with cytokines and decrease in lung function in women with persistent asthma

Abdominal obesity is associated with a risk of cardiovascular diseases, metabolic syndrome and decreased lung function. However, it is not known whether asthma control is influenced by the accumulation of adipose tissue in the various abdominal compartments.

OBJECTIVE

To determine associations among abdominal adiposity distribution, asthma control, lung function and cytokines in women.

METHODS AND DESIGN

In this cross-sectional study of asthmatic women, data on demographic variables, comorbid conditions, disease history, anthropometric and spirometric measurements were collected. Subcutaneous (SAT) and visceral (VAT) adipose tissues were measured by ultrasound, and the steatosis level was obtained. Asthma control was assessed according to Global Initiative for Asthma (GINA) criteria. Atopy was defined on the basis of allergen-specific Immunoglobulin E and/or skin prick testing. Cytokine levels were determined using enzyme-linked immunosorbant assays (ELISAs).

RESULTS

Eighty-three asthmatic women were included, 37% of whom had uncontrolled asthma. After controlling for variables, a negative association between asthma control and VAT and the VAT/SAT ratio was observed. VAT was negatively associated with respiratory parameters after controlling for explanatory variables. In an adjusted model, body mass index (BMI) and SAT were inversely associated with the adiponectin serum level and VAT was associated with the interleukin 6 level. In conclusion, visceral obesity was negatively associated with asthma control and lung function; and positively associated with increased levels of interleukin 6 in women. We hypothesize that women should be studied as a separate group, and we suggest further studies with a control group to know if the uncontrolled asthmatic group is directly affected by visceral adipose inflammatory markers.

Diagnosis and investigation in the severe asthma clinic

Severe asthma is recognised as an important and emerging area of unmet need in asthma. The assessment of severe asthma should include three steps; (1) determining the diagnosis of asthma, including verification that the disease is severe asthma, (2) assessing comorbidities and contributing factors that will impact on clinical severity, as well as (3) assessing asthma phenotypes. These steps recognize the importance of heterogeneity in asthma as a key factor that determines the disease course and increasingly the choice of successful therapy. This assessment should be undertaken systematically and is best done by an expert multidisciplinary team. Here, we will outline the important aspects that should be included in the clinical assessment of the patient in the severe asthma clinic, including diagnosis, clinical history, the assessment of important comorbidities and the key investigations needed to support them.