Chest
Clinical InvestigationsASTHMABody Mass Index and Asthma Severity Among Adults Presenting to the Emergency Department
Section snippets
Materials and Methods
This prospective cohort study was performed during November 2000 to May 2001 as part of the Multicenter Airway Research Collaboration (MARC).28 Using a standardized protocol, investigators at 26 EDs in 15 US states and 1 Canadian province provided 24-h per day coverage for a median of 2 weeks. All patients were managed at the discretion of the treating physician. Inclusion criteria were physician diagnosis of acute asthma, age 18 to 54 years, and ability to give informed consent. Repeat visits
Results
The 572 patients had a mean age of 37 ± 10 years, and 66% (95% CI, 62 to 70) were women. As expected in this urban population, most subjects were black (44%) or Hispanic (26%), with only 30% white. The smoking status of these ED patients was never smoker (38%), former smoker (26%), and current smoker (36%). Only 3% reported comorbid COPD and the exclusion of these patients from analyses did not materially change any results (data not shown).
Figure 1shows the BMI classification of these
Discussion
Many epidemiologic studies have noted the striking increase in both obesity1,2,3,5,6,7 and asthma,13,14 and both cross-sectional16,22,24,25,26,27,34,35 and longitudinal8,36,37,38 studies have attempted to document a link between these two chronic disorders. Our study is the first to examine the association between BMI and acute asthma severity among adults presenting to the ED. The prevalence of obesity among asthmatic adults in the ED was significantly higher than that of adults from the
Conclusion
In conclusion, our study supports the assertion that obese adults present to the ED with asthma exacerbations that are remarkably similar to those of nonobese adults. Compared to normal/underweight and overweight individuals, obese individuals were treated similarly and responded similarly to treatment. At least in the ED setting, these real-world data refute claims that the asthma of many obese individuals is not true asthma but instead an exaggerated dyspnea without evidence of airway
EMNet Steering Committee
Edwin D. Boudreaux, PhD; Barry E. Brenner, MD, PhD; Carlos A. Camargo, Jr, MD (Chair); Rita K. Cydulka, MD; Theodore J. Gaeta, DO, MPH; Michael S. Radeos, MD, MPH.
EMNet Coordinating Center
Keith Brinkley, MA; Carlos A. Camargo, Jr, MD (Director); Sunday Clark, MPH; Jennifer A. Emond, MS; Jessica L. Hohrmann, MPH; Sunghye Kim, MD (all at Massachusetts General Hospital, Boston).
Principal Investigators at the 30 Participating Sites
M.P. Blanda (Akron City Hospital, Akron, OH); E.D. Boudreaux (Earl K. Long Memorial Hospital, Baton Rouge, LA); J.C. Brancato (Connecticut
ACKNOWLEDGMENT
We thank the MARC Investigators for their ongoing dedication to emergency airway research.
References (44)
- et al.
The health economics of asthma and rhinitis: I. Assessing the economic impact
J Allergy Clin Immunol
(2001) - et al.
Difference between men and women in reporting of symptoms during an asthma exacerbation
Ann Emerg Med
(2001) - et al.
Leisure-time energy expenditure in asthmatics and non-asthmatics
Respir Med
(2001) Obesity: preventing and managing the global epidemic; report of a World Health Organization consultation on obesity
(1997)Controlling the global obesity epidemic 2001 World Health Organization. Geneva, Switzerland
- et al.
Overweight and obesity in the United States: prevalence and trends, 1960–1994
Int J Obes Relat Metab Disord
(1998) - et al.
Guidelines for healthy weight
N Engl J Med
(1999) - National Center for Health Statistics. Prevalence of overweight and obesity in adults: US, 1999. Hyattsville, MD: US...
Behavioral risk factor surveillance system: prevalence of overweight and obesity 2000. 2003 National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention. Washington, DC
- et al.
The continuing epidemics of obesity and diabetes in the United States
JAMA
(2001)
Obesity may increase the incidence of asthma in women but not in men: longitudinal observations from the Canadian National Population Health Surveys
Am J Epidemiol
The influence of age and sex on asthma admissions
JAMA
The natural history of the development of obesity in a cohort of young U.S. adults between 1981 and 1998
Ann Intern Med
Increasing prevalence of overweight among US adults: the National Health and Nutrition Examination Surveys, 1960 to 1991
JAMA
Surveillance for asthma–United States, 1960–1995
Morb Mortal Wkly Rep CDC Surveill Summ
Evidence for the increase in asthma worldwide
Ciba Found Symp
Race and gender differences in respiratory illness prevalence and their relationship to environmental exposures in children 7 to 14 years of age
Am Rev Respir Dis
The relationship between asthma and obesity in urban minority children and adolescents
Arch Pediatr Adolesc Med
Predictors of asthma and persistent wheeze in a national sample of children in the United States
Am Rev Respir Dis
Body mass index and asthma in adults in families of subjects with asthma in Anqing, China
Am J Respir Crit Care Med
Cited by (0)
Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (e-mail:[email protected]).
Dr. Thomson is supported by grant HL-707427, and Dr. Camargo by grant HL-63841 from the National Institutes of Health (Bethesda, MD). The project was supported by grant HL-63253 from the National Institutes of Health, and by an unrestricted grant from GlaxoSmithKline (Research Triangle Park, NC).