Weight-loss practices and asthma: findings from the behavioral risk factor surveillance system

Predictors of a good response to inhaled corticosteroids in obesity-associated asthma

INTRODUCTION

Asthma in obese subjects is poorly understood. According to GINA guidelines, pulmonologists increase ICS in case of poor asthma control but lung volume restriction may also worsen respiratory symptoms in obese asthmatics leading to overtreatment in this subpopulation.

METHODS

We conducted a retrospective study on 1217 asthmatics recruited from University Hospital of Liege. 92 patients with a BMI ≥30 came at least two times at the asthma clinic (mean interval: 335 days). In this obese population, we identified predictors of good (decrease in ACQ ≥0.5) versus poor response (rise in ACQ ≥0.5) to ICS step-up therapy.

RESULTS

Obese asthmatics had a poorer asthma control and quality of life as compared to non-obese and exhibited reduced FVC, higher levels of blood leucocytes and markers of systemic inflammation. The proportion of asthma inflammatory phenotypes was similar to that observed in a general population of asthmatics. Among uncontrolled obese asthmatics receiving ICS step-up therapy, 53% improved their asthma control while 31% had a worsening of their asthma. Uncontrolled obese asthmatics showing a good response to increase in ICS had higher ACQ, lower CRP levels, higher sputum eosinophil counts and higher FeNO levels at visit 1. Uncontrolled obese asthmatics that worsened after increasing the dose of ICS had lower FVC, lower sputum eosinophil counts and higher sputum neutrophil counts.

CONCLUSION

We observed poorer asthma control in obese asthmatics despite similar bronchial inflammation. Managing obese asthmatics according to ACQ alone seems to underestimate asthma control and the contribution of restriction to dyspnea. Increasing the dose of ICS in the absence of sputum eosinophilic inflammation or in the presence of restriction or bronchial neutrophilia led to poorer asthma control. In those patients, management of obesity should be the first choice.

Overweight adolescents and asthma: Revealing motivations and challenges with adolescent-provider communication

OBJECTIVE

Among teens with asthma, challenges of disease management may be greater in those with a body mass index (BMI) >85th percentile compared to youth within the parameters for normal weight-for-age. This mixed-methods study assessed teens' awareness of the link between weight and asthma management, and perspectives on how medical providers might open a discussion about managing weight.

METHOD

Teens aged 13-18, having BMI >85 percentile and chronic asthma, identified using health system databases and a staff email message board, were invited to complete a semi-structured, in-depth phone interview. Interviews were audio taped, transcribed, and qualitatively analyzed, using the Framework Method. Responses were summarized and themes identified. Descriptive summaries were generated for a 16-item survey of weight conversation starters.

RESULTS

Of 35 teens interviewed, 24 (69%) were girls, 11 (31%) boys, 20 (63%) African-American. All teens reported having "the weight conversation" with their doctors, and preferred that parents be present. Half knew from their doctor about the link between being overweight and asthma, others knew from personal experience. Nearly all expressed the importance of providers initiating a weight management conversation. Most preferred conversation starters that recognized challenges and included parents' participation in weight management; least liked referred to "carrying around too much weight."

CONCLUSIONS

Most teens responded favorably to initiating weight loss if it impacted asthma management, valued their provider addressing weight and family participation in weight management efforts. Adolescents' views enhance program development fostering more effective communication targeting weight improvement within the overall asthma management plan.

Changes in Obesity Prevalence Among Women Aged 50 Years and Older

Obesity is an important public health issue facing Americans of all ages. Behavioral Risk Factor Surveillance System data are used to illustrate the change in body mass index distribution in just one decade (1990-2000) in women aged = 50. The sample size ranged from 18,474women = 50 in 1990 to 45,820 in 2000. Forwomen aged = 50, there is a slight decline in the prevalence of underweight (from 3.1% in 1990 to 2.4% in 2000) and a significant increase in obesity (from 14.4% to 21.7%). Not smoking, having less education, being in poor health, having diabetes, and not exercising are all associated with increased odds of being obese. Although factors significantly related to obesity in older women are consistent with those previously identified in younger women, the weight group distributions in olderwomen differ. The physical and social influences of age and gender need to be incorporated into health promotion programs.

Asthma and obesity: does weight loss improve asthma control? a systematic review

Aim and methods

Obesity is a major health problem, and obesity is associated with a high incidence of asthma and poor asthma control. The aim of the present paper is to systematically review the current knowledge of the effect on overall asthma control of weight reduction in overweight and obese adults with asthma.

Results

Weight loss in obese individuals with doctor-diagnosed asthma is associated with a 48%–100% remission of asthma symptoms and use of asthma medication. Published studies, furthermore, reveal that weight loss in obese asthmatics improves asthma control, and that especially surgically induced weight loss results in significant improvements in asthma severity, use of asthma medication, dyspnoea, exercise tolerance, and acute exacerbations, including hospitalizations due to asthma. Furthermore, weight loss in obese asthmatics is associated with improvements in level of lung function and airway responsiveness to inhaled methacholine, whereas no significant improvements have been observed in exhaled nitric oxide or other markers of eosinophilic airway inflammation.

Conclusion

Overweight and obese adults with asthma experience a high symptomatic remission rate and significant improvements in asthma control, including objective measures of disease activity, after weight loss. Although these positive effects of weight loss on asthma-related health outcomes seem not to be accompanied by remission or improvements in markers of eosinophilic airway inflammation, it has potentially important implications for the future burden of asthma.

Mediterranean diet and asthma in Spanish schoolchildren

There is still debate on the effect of dietetic factors on the prevalence or severity of asthma, as well as the interaction with other factors. We have analysed the prevalence and severity of asthma according to adherence to the Mediterranean diet (MD), its association with obesity and family life style. We performed a cross-sectional study on 14,700 children and adolescents in six health areas in our region. We used the International Study of Asthma and Allergies in Childhood questionnaire to collect asthma symptoms, dietary habits, anthropometric parameters, parental smoking habits and maternal education level. The diet pattern was analysed using a Mediterranean Diet Score. In the logistic regression we analysed the influence of adhering to the MD on the prevalence and severity of asthma, adjusted for the other parameters included. Greater adherence to the MD is associated with a higher risk of severe asthma (odds ratios = 2.26, 95% CI: 1.21-4.22) in girls of 6-7 yr. There was no significant relationship for the other asthma categories in the population studied. The results of our study do not support a protective effect of the MD on the prevalence or severity of asthma.

Binge drinking, poor mental health, and adherence to treatment among California adults with asthma

Binge drinking and poor mental health may affect adherence to treatment for individuals with asthma. The purposes were to (a) examine the relationship of self-reported binge drinking and mental health to adherence to daily asthma control medications and (b) identify other demographic and health-related factors associated with asthma control medication adherence. Secondary analyses of 2003 adult California Health Interview Survey data were undertaken, and these analyses identified 3.2 million California adults who had been told by a physician they had asthma. Of these, approximately 1.7 million were symptomatic. Binge drinking significantly predicted medication nonadherence among California adults with symptomatic asthma (OR = .63, 95% CI = .45-.89), whereas poor mental health did not. Other predictors of nonadherence (odds ratios < 1, p < .05) included being overweight, younger age, having some college education, being a current smoker, and having no usual source of medical care. Predictors of adherence (odds ratios > 1, p < .05) were older age, more frequent asthma symptoms, more ER visits, more missed work days, being African American, and being a non-citizen. Intervention efforts could be directed toward improving medication adherence among adult asthma patients who engage in risky health behaviors such as binge drinking. Also at risk for medication nonadherence and therefore good targets for asthma control medication management interventions are adults who are overweight, younger (18-44 age range), have some college education, and no usual source of medical care.

Excessive body weight is associated with additional loss of quality of life in children with asthma

BACKGROUND

Asthma and excessive body weight frequently coexist, whereas the exact relationship between the 2 diseases is unknown.

OBJECTIVE

To study whether asthma combined with excessive body weight has a greater effect on quality of life in children than the separate effects of asthma or excessive body weight alone.

METHODS

In a cross-sectional design, 1758 school children (age 7-10 years) participated: 4 study groups were composed of children with asthma and with/without excessive body weight, and healthy controls with/without excessive body weight. Diagnosis of asthma was defined by either a doctor's diagnosis or by core questions of the International Study of Asthma and Allergies in Childhood questionnaire in combination with either reversible airway obstruction or bronchial hyperresponsiveness. Excessive body weight was defined by using international cutoff points for body mass index. Quality of life was evaluated by the Pediatric Asthma Quality of Life Questionnaire.

RESULTS

For all domains of quality of life, children with both asthma and excessive body weight had lower scores than children with either asthma alone or excessive body weight alone. Compared with healthy controls, the score was 25% lower in children with asthma and excessive body weight, 14% lower in children with asthma and normal weight, and only 1% lower in overweight controls.

CONCLUSION

Excessive body weight is associated with an additional decrease in quality of life in children with asthma.

CLINICAL IMPLICATIONS

Clinicians should be aware of the interaction between asthma and excessive body weight and the effect on quality of life and should give extra attention to children with both conditions.

Risk behaviors and health-related quality of life among adults with asthma: the role of mental health status

BACKGROUND

Previous research indicates that asthma is strongly associated with depressive disorders. Depression among persons with asthma is associated with poor adherence to medication regimens, more severe asthma, and poorer disease outcomes. The objective of our study was to examine the association of frequent mental distress (FMD) [ie, > or = 14 days in the past 30 days in which respondents reported that their mental health was not good] with modifiable risk behaviors (ie, smoking, physical inactivity, and obesity) and health-related quality of life among adults with asthma.

METHODS

The Behavioral Risk Factor Surveillance System is an ongoing, state-based survey that is conducted by random-digit dialing of noninstitutionalized US adults aged > or = 18 years. In 2001, all 50 states administered the asthma and risk behavior questionnaires (15,080 questionnaires). A total of 12 states administered the health-related quality-of-life questionnaire (3,226 questionnaires). We estimated prevalences, 95% confidence intervals, odds ratios, and adjusted odds ratios (AORs) using a statistical software program to account for the complex survey design.

RESULTS

The prevalence of FMD among adults with asthma was 18.8%. After adjusting for sociodemographic characteristics, the overall associations between smoking and FMD (AOR, 1.9), and between physical inactivity and FMD (AOR, 1.7) were statistically significant. In addition, among those with asthma, persons with FMD were significantly more likely than those without FMD to report fair/poor general health, frequent physical distress, frequent activity limitations, frequent anxiety, and frequent sleeplessness.

CONCLUSIONS

FMD is highly prevalent among persons with asthma, suggesting an apparent synergistic effect of these two conditions. The assessment of the mental health status of persons with asthma by health-care providers appears to be warranted and may prevent the emergence of risk behaviors yielding deleterious effects on the management of this disease.

Persistence of asthma symptoms during adolescence: role of obesity and age at the onset of puberty

Little is known about rates and predictors of remission of childhood asthma after the onset of puberty. We used data collected at ages 6, 8, 11, 13, and 16 years from the Tucson Children's Respiratory Study, a population-based birth cohort. The onset of puberty was defined as the age of appearance of the first pubertal signs as reported by parents. Information on wheezing both before and after onset of puberty (mean +/- SD follow-up from onset of puberty, 4.2 +/- 1 year) was available for 781 children. Of these, 166 had asthma (either frequent wheezing or a physician-confirmed diagnosis plus any wheezing) in at least one survey before puberty. In this group, 58% of the children (97 of 166) reported the presence of wheezing after the onset of puberty (unremitting asthma). In contrast, only 30% (39 of 131) of the children with infrequent wheezing before puberty experienced wheezing episodes after the onset of puberty (unremitting wheezing). In addition to frequent wheezing before puberty, obesity, early onset of puberty, active sinusitis, and skin test sensitization were significant and independent predictors of unremitting asthma after the onset of puberty. Our findings from a population-based longitudinal cohort challenge the commonly held view that asthma usually remits during adolescence.