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Dupuis A, Thierry A, Perotin JM, Ancel J, Dormoy V, Dury S, Deslée G, Launois C. Obesity Impact on Dyspnea in COPD Patients. Int J Chron Obstruct Pulmon Dis 2024; 19:1695-1706. [PMID: 39070800 PMCID: PMC11277818 DOI: 10.2147/copd.s450366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Accepted: 04/26/2024] [Indexed: 07/30/2024] Open
Abstract
Background The role of obesity on dyspnea in chronic obstructive pulmonary disease (COPD) patients remains unclear. We aimed to provide an assessment of dyspnea in COPD patients according to their Body Mass Index (BMI) and to investigate the impact of obesity on dyspnea according to COPD severity. Methods One hundred and twenty seven COPD patients with BMI ≥ 18.5 kg/m² (63% male, median (interquartile range) post bronchodilator forced expiratory volume of 1 second (post BD FEV1) at 51 (34-66) % pred) were consecutively included. Dyspnea was assessed by mMRC (Modified medical research council) scale. Lung function tests were recorded, and emphysema was quantified on CT-scan (computed tomography-scan). Results Twenty-five percent of the patients were obese (BMI ≥ 30kg/m²), 66% of patients experienced disabling dyspnea (mMRC ≥ 2). mMRC scores did not differ depending on BMI categories (2 (1-3) for normal weight, 2 (1-3) 1 for overweight and 2 (1-3) for obese patients; p = 0.71). Increased mMRC scores (0-1 versus 2-3 versus 4) were associated with decreased post BD-FEV1 (p < 0.01), higher static lung hyperinflation (inspiratory capacity/total lung capacity (IC/TLC), p < 0.01), reduced DLCO (p < 0.01) and higher emphysema scores (p < 0.01). Obese patients had reduced static lung hyperinflation (IC/TLC p < 0.01) and lower emphysema scores (p < 0.01) than non-obese patients. mMRC score increased with GOLD grades (1-2 versus 3-4) in non-obese patients but not in obese patients, in association with a trend towards reduced static lung hyperinflation and lower emphysema scores. Conclusion By contrast with non-obese patients, dyspnea did not increase with spirometric GOLD grades in obese patients. This might be explained by a reduced lung hyperinflation related to the mechanical effects of obesity and a less severe emphysema in severe COPD patients with obesity.
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Affiliation(s)
- Alexis Dupuis
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Aurore Thierry
- Université de Reims Champagne-Ardenne, VieFra, CHU Reims, Unité d’Aide Méthodologique, Reims, F-51100, France
| | - Jeanne-Marie Perotin
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Julien Ancel
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Valérian Dormoy
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Sandra Dury
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
| | - Gaëtan Deslée
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
| | - Claire Launois
- Department of Respiratory Diseases, University Hospital of Reims, Reims, France
- University of Reims Champagne-Ardenne (URCA), Inserm UMR-S 1250, SFR Cap-Santé, Reims, France
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Maxwell CV, Shirley R, O'Higgins AC, Rosser ML, O'Brien P, Hod M, O'Reilly SL, Medina VP, Smith GN, Hanson MA, Adam S, Ma RC, Kapur A, McIntyre HD, Jacobsson B, Poon LC, Bergman L, Regan L, Algurjia E, McAuliffe FM. Management of obesity across women's life course: FIGO Best Practice Advice. Int J Gynaecol Obstet 2023; 160 Suppl 1:35-49. [PMID: 36635081 PMCID: PMC10107516 DOI: 10.1002/ijgo.14549] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Obesity is a chronic, progressive, relapsing, and treatable multifactorial, neurobehavioral disease. According to the World Health Organization, obesity affects 15% of women and has long-term effects on women's health. The focus of care in patients with obesity should be on optimizing health outcomes rather than on weight loss. Appropriate and common language, considering cultural sensitivity and trauma-informed care, is needed to discuss obesity. Pregnancy is a time of significant physiological change. Pre-, ante-, and postpartum clinical encounters provide opportunities for health optimization for parents with obesity in terms of, but not limited to, fertility and breastfeeding. Pre-existing conditions may also be identified and managed. Beyond pregnancy, women with obesity are at an increased risk for gastrointestinal and liver diseases, impaired kidney function, obstructive sleep apnea, and venous thromboembolism. Gynecological and reproductive health of women living with obesity cannot be dismissed, with accommodations needed for preventive health screenings and consideration of increased risk for gynecologic malignancies. Mental wellness, specifically depression, should be screened and managed appropriately. Obesity is a complex condition and is increasing in prevalence with failure of public health interventions to achieve significant decrease. Future research efforts should focus on interprofessional care and discovering effective interventions for health optimization.
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Affiliation(s)
- Cynthia V Maxwell
- Maternal Fetal Medicine; Sinai Health and Women's College Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Rachelle Shirley
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Amy C O'Higgins
- Maternal Fetal Medicine, Sinai Health, University of Toronto, Toronto, Ontario, Canada
| | - Mary L Rosser
- Department of Obstetrics and Gynecology, Columbia University Irving Medical Center, New York-Presbyterian, New York, New York, USA
| | - Patrick O'Brien
- Institute for Women's Health, University College London, London, UK
| | - Moshe Hod
- Helen Schneider Hospital for Women, Rabin Medical Center, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Sharleen L O'Reilly
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland.,School of Agriculture and Food Science, University College Dublin, Dublin, Ireland
| | - Virna P Medina
- Department of Obstetrics and Gynecology, Faculty of HealthUniversidad del Valle, Clínica Imbanaco Quirón Salud, Universidad Libre, Cali, Colombia
| | - Graeme N Smith
- Department of Obstetrics and Gynecology, Kingston Health Sciences Centre, Queen's University, Kingston, Ontario, Canada
| | - Mark A Hanson
- Institute of Developmental Sciences, University Hospital Southampton, Southampton, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, UK
| | - Sumaiya Adam
- Department of Obstetrics and Gynecology, School of Medicine, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,Diabetes Research Centre, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
| | - Ronald C Ma
- Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong, SAR, China.,Hong Kong Institute of Diabetes and Obesity, The Chinese University of Hong Kong, Hong Kong, SAR, China
| | - Anil Kapur
- World Diabetes Foundation, Bagsvaerd, Denmark
| | - Harold David McIntyre
- Mater Health, University of Queensland, Mater Health Campus, South Brisbane, Queensland, Australia
| | - Bo Jacobsson
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital/Ostra, Gothenburg, Sweden.,Department of Genetics and Bioinformatics, Domain of Health Data and Digitalisation, Institute of Public Health, Oslo, Norway
| | - Liona C Poon
- Department of Obstetrics and Gynecology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong, SAR, China
| | - Lina Bergman
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Obstetrics and Gynecology, Stellenbosch University, Cape Town, South Africa.,Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | | | - Esraa Algurjia
- The World Association of Trainees in Obstetrics & Gynecology, Paris, France.,Elwya Maternity Hospital, Baghdad, Iraq
| | - Fionnuala M McAuliffe
- UCD Perinatal Research Centre, School of Medicine, University College Dublin, National Maternity Hospital, Dublin, Ireland
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3
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Guo YL, Ampon MR, Poulos LM, Davis SR, Toelle BG, Marks GB, Reddel HK. Contribution of obesity to breathlessness in a large nationally representative sample of Australian adults. Respirology 2022; 28:350-356. [PMID: 36336647 DOI: 10.1111/resp.14400] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 10/23/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND AND OBJECTIVE Breathlessness is prevalent and associated with medical consequences. Obesity is related to breathlessness. However, the magnitude of its contribution has not been clearly documented. This investigation aimed to determine the contribution of obesity to breathlessness by estimating the population attributable fraction (PAF) in a representative sample of Australian adults. METHODS A cross-sectional, nationally representative survey of Australian residents aged ≥18 years was conducted in October 2019. Breathlessness was defined as modified Medical Research Council (mMRC) dyspnoea scale grade ≥2. BMI was calculated from self-reported height and weight. Adjusted relative risks (aRRs) were estimated using a generalized linear model with Poisson distribution, adjusted for age group and/or participant-reported diagnosed illnesses. Adjusted PAFs were estimated using aRR and obesity prevalence in Australian adults. RESULTS Among those who completed the National Breathlessness Survey, 9769 participants (51.4% female) were included in the analysis; 28.1% of participants were obese. The prevalence of breathlessness was 9.54%. The aRR of obesity for breathlessness was 2.04, adjusted for age. Adjusting for various co-morbid conditions, the aRR was slightly attenuated to around 1.85-1.98. The PAF, adjusted only for age, was 24.6% (95% CI 20.1-29.1) and after further adjustment for co-morbid conditions, the PAF ranged from 21.1% to 23.6%. Obesity accounted for a higher proportion of breathlessness in women than in men. CONCLUSION Our results demonstrate that obesity accounts for around a quarter of breathlessness symptoms in Australian adults. This has important implications for health policy in light of the global trend in increasing obesity.
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Affiliation(s)
- Yue Leon Guo
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Department of Environmental and Occupational Medicine National Taiwan University (NTU) College of Medicine and NTU Hospital Taipei Taiwan
- Institute of Environmental and Occupational Health Sciences National Taiwan University College of Public Health Taipei Taiwan
| | - Maria R. Ampon
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Leanne M. Poulos
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Sharon R. Davis
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
| | - Brett G. Toelle
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Sydney Local Health District Sydney New South Wales Australia
| | - Guy B. Marks
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- School of Clinical Medicine UNSW Medicine & Health, University of New South Wales Sydney New South Wales Australia
| | - Helen K. Reddel
- Australian Centre for Airways disease Monitoring (ACAM) The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
- Respiratory and Environmental Epidemiology The Woolcock Institute of Medical Research, The University of Sydney Sydney New South Wales Australia
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Umemura A, Sasaki A, Nikai H, Yanari S, Ishioka H, Takahashi N, Katagiri H, Kanno S, Takeda D, Morishita T, Eizuka M, Oizumi T, Nitta H. Improvements of lung volumes and respiratory symptoms after weight loss through laparoscopic sleeve gastrectomy. Langenbecks Arch Surg 2022; 407:2747-2754. [PMID: 35588327 DOI: 10.1007/s00423-022-02549-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Accepted: 05/07/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE This study evaluated the improvement of respiratory function and airway volumes using spirometry and computed tomography (CT) in severely obese Japanese patients undergoing laparoscopic sleeve gastrectomy (LSG). We also evaluated the quality of life (QOL) of enrolled patients using questionnaires. METHODS A total of 71 patients who underwent LSG at Iwate Medical University Hospital between October 2013 and September 2020 were enrolled. The changes and relationships between respiratory parameters including CT volumetry and weight-loss effects were evaluated. Improvements to QOL and bronchial asthma (BA) were also assessed before LSG and 1 year after LSG. RESULTS The mean excess weight loss percentage (%EWL) and total weight loss percentage (%TWL) were measured at 55.1% and 26.1%, respectively. The attack frequency of BA significantly decreased (6.1/month vs. 1.5/month; P < 0.001), and the disease severity decreased according to severity classification (P = 0.032). Almost spirometric parameters, lung volume (LV) (4905.0 mL vs. 5490.3 mL; P < 0.001), and airway volume (AV) (108.6 mL vs. 119.3 mL; P = 0.022) significantly improved. The change of functional residual capacity (FRC) was correlated with both %EWL (ρ = 0.69, P < 0.001) and %TWL (ρ = 0.62, P < 0.001). The increase of LV (ρ = 0.79, P < 0.001) and AV (ρ = 0.69, P < 0.001) were correlated with the increase of FRC. Scores of QOL questionnaires dramatically became better owing to improvements in dyspnea. CONCLUSION Weight loss effects and the reduction of body fat mass correlated significantly with increase in LV and AV. Improvements of respiratory functions after LSG contributes to QOL and BA symptoms.
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Affiliation(s)
- Akira Umemura
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan.
| | - Akira Sasaki
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Haruka Nikai
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shingo Yanari
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hideki Ishioka
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Naoto Takahashi
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hirokatsu Katagiri
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Shoji Kanno
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Daiki Takeda
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Toshifumi Morishita
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Makoto Eizuka
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Tomofumi Oizumi
- Division of Gastroenterology, Department of Internal Medicine, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
| | - Hiroyuki Nitta
- Department of Surgery, Iwate Medical University, 2-1-1 Idaidori, Yahaba, 028-3695, Japan
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5
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Hagenburg J, Bertin E, Salmon JH, Thierry A, Perotin JM, Dormoy V, Dury S, Gaubil I, Bolko L, Lebargy F, Deslee G, Launois C. Association between obesity-related dyspnea in daily living, lung function and body composition analyzed by DXA: a prospective study of 130 patients. BMC Pulm Med 2022; 22:103. [PMID: 35337302 PMCID: PMC8957162 DOI: 10.1186/s12890-022-01884-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 03/09/2022] [Indexed: 01/01/2023] Open
Abstract
Background Obesity is a risk factor for dyspnea. However, investigations of daily living obesity-related dyspnea are limited and its mechanisms remain unclear. We conducted a cross-sectional study to analyze the relationships between dyspnea in daily living, lung function, and body composition in patients with obesity. Methods One-hundred and thirty patients (103 women/27 men), candidate for bariatric surgery, with a mean ± SD Body Mass Index (BMI) of 44.8 ± 6.8 kg/m2 were included. Dyspnea was assessed by the modified Medical Research Council (mMRC) scale. Comorbidities, laboratory parameters, pulmonary function tests, arterial blood gases, six-minute walk test (6MWT), handgrip strength, and DXA body composition were analyzed. Results Thirty-one percent of patients exhibited disabling dyspnea in daily living (mMRC ≥ 2). Compared with patients without disabling dyspnea (mMRC < 2), significant dyspnea (mMRC ≥ 2) was associated with a lower 6MWT distance (395 ± 103 m vs 457 ± 73 m, p < 0.001), lower lung volumes including Expiratory Reserve Volume (42 ± 28% vs 54 ± 27%, p = 0.024), Vital Capacity (95 ± 14 vs 106 ± 15%, p < 0.001) and Forced expiratory volume in one second (95 ± 13 vs 105 ± 15%, p = 0.002), a higher BMI (48.2 ± 7.7 vs 43.2 ± 5.7 kg/m2, p = 0.001) and a higher percentage of fat mass in the trunk (46 ± 5 vs 44 ± 5 p = 0.012) and android region (52 ± 4 vs 51 ± 4%, p = 0.024). There was no difference regarding comorbidities (except hypertension), laboratory parameters, and sarcopenia markers between patients with (mMRC ≥ 2) and without (mMRC < 2) disabling dyspnea. Conclusion Dyspnea in patients with obesity is associated with a reduction in lung volumes and a higher percentage of fat mass in central body regions. How dyspnea and body composition may change with interventions like physical activity or bariatric surgery remains to be investigated. Supplementary Information The online version contains supplementary material available at 10.1186/s12890-022-01884-5.
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Affiliation(s)
- Jean Hagenburg
- Service Des Maladies Respiratoires, CHU Reims, Reims, France
| | - Eric Bertin
- Service d'Endocrinologie Diabète Nutrition, Centre Spécialisé Obésité, CHU Reims, Reims, France
| | | | | | - Jeanne-Marie Perotin
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.,INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Valérian Dormoy
- INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Sandra Dury
- Service Des Maladies Respiratoires, CHU Reims, Reims, France
| | - Isabelle Gaubil
- Service d'Endocrinologie Diabète Nutrition, Centre Spécialisé Obésité, CHU Reims, Reims, France
| | - Lois Bolko
- Service de Rhumatologie, CHU Reims, Reims, France
| | | | - Gaëtan Deslee
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.,INSERM UMR-S 1250 "Pathologies Pulmonaires Et Plasticité Cellulaire", Reims, France
| | - Claire Launois
- Service Des Maladies Respiratoires, CHU Reims, Reims, France.
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Gao D, Sun L, Wang N, Shi Y, Song J, Liu X, Yang Q, Su Z. Impact of 30° Reserve Trendelenburg Position on Lung Function in Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy. Front Surg 2022; 9:792697. [PMID: 35284476 PMCID: PMC8907616 DOI: 10.3389/fsurg.2022.792697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Background This study aimed to evaluate the impact of patients' positioning before and after intubation with mechanical ventilation, and after extubation on the lung function and blood oxygenation of patients with morbid obesity, who had a laparoscopic sleeve gastrectomy. Methods Patients with morbid obesity (BMI ≥ 30 kg/m2, ASA I – II grade) who underwent laparoscopic sleeve gastrectomy at our hospital from June 2018 to January 2019 were enrolled in this prospective study. Before intubation, after intubation with mechanical ventilation, and after extubation, arterial blood was collected for blood oxygenation and gas analysis after posturing the patients at supine position or 30° reverse Trendelenburg position (30°-RTP). Results A total of 15 patients with morbid obesity were enrolled in this self-compared study. Pulmonary shunt (Qs/Qt) after extubation was significantly lower at 30°-RTP (18.82 ± 3.60%) compared to that at supine position (17.13 ± 3.10%, p < 0.01). Patients' static lung compliance (Cstat), during mechanical ventilation, was significantly improved at 30°-RTP (36.8 ± 6.7) compared to that of those in a supine position (33.8 ± 7.3, p < 0.05). The PaO2 and oxygen index (OI) before and after intubation with mechanical ventilation were significantly higher at 30°-RTP compared to that at supine position, and in contrast, the PA−aO2 before and after intubation with mechanical ventilation was significantly reduced at 30°-RTP compared to that at supine position. Conclusion During and after laparoscopic sleeve gastrectomy, patients with morbid obesity had improved lung function, reduced pulmonary shunt, reduced PA−aO2 difference, and increased PaO2 and oxygen index at 30°-RTP compared to that supine position.
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Affiliation(s)
- Dengyu Gao
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Lu Sun
- Department of Anesthesiology, The First Affiliated Hospital of Xiamen University, Xiamen, China
| | - Ning Wang
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Yubo Shi
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Jianli Song
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Xiaoying Liu
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
| | - Qiyao Yang
- Education Centre, China Medical Tribun, Beijing, China
| | - Zhenbo Su
- Department of Anesthesiology, China-Japan Union Hospital of Jilin University, Changchun, China
- *Correspondence: Zhenbo Su
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Vetrovsky T, Fortova T, Conesa-Ros E, Steffl M, Heczkova J, Belohlavek J, Courel-Ibáñez J. Increased Cardiopulmonary Fitness Is Associated with a Greater Reduction in Depression among People Who Underwent Bariatric Surgery. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18052508. [PMID: 33802552 PMCID: PMC7967516 DOI: 10.3390/ijerph18052508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/26/2022]
Abstract
The aim of this study was to determine the effect of changes in cardiopulmonary fitness on the mental health of patients with severe obesity who underwent gastric bypass surgery (prior to and 1, 3, and 6 months after surgery). Study participants were recruited from among patients of a regional hospital in Czechia who underwent gastric bypass surgery between April 2018 and October 2019. They were eligible if they (a) were between 18 and 65 years old, (b) provided written informed consent, and (c) were able to walk independently. Twenty-six patients (age 45.4 ± 9.0 years, body mass index 45.1 ± 7.4 kg·m−2, body fat 43.8 ± 4.8%) were included in the analysis. The key finding revealed that the greater the increase in cardiopulmonary fitness (i.e., longer distance walked in the six-minute walk test, 6MWT), the better the improvement in depression score among patients who underwent bariatric surgery. In particular, increments of 10 m in the 6MWT lead to the improvement of 0.5 points on the depression subscale of the Hospital Anxiety and Depression Scale (HADS) questionnaire. As the main implication, these results suggest that patients should participate in exercise training programs to increase their fitness status for optimal physical and mental outcomes of bariatric surgery.
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Affiliation(s)
- Tomas Vetrovsky
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Tereza Fortova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
- Hospital Jablonec nad Nisou, 466 01 Jablonec nad Nisou, Czech Republic
| | - Elena Conesa-Ros
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain;
| | - Michal Steffl
- Faculty of Physical Education and Sport, Charles University, 162 52 Prague, Czech Republic;
| | - Jana Heczkova
- Institute of Nursing Theory and Practice, First Faculty of Medicine, Charles University, 128 00 Prague, Czech Republic; (T.V.); (T.F.); (J.H.)
| | - Jan Belohlavek
- 2nd Department of Internal Medicine, Cardiovascular Medicine, General University Hospital, 128 08 Prague, Czech Republic;
- 1st Faculty of Medicine, Charles University in Prague, 128 00 Prague, Czech Republic
| | - Javier Courel-Ibáñez
- Human Performance and Sports Science Laboratory, Faculty of Sport Sciences, University of Murcia, 30720 Murcia, Spain;
- Correspondence:
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8
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Brock JM, Billeter A, Müller-Stich BP, Herth F. Obesity and the Lung: What We Know Today. Respiration 2020; 99:856-866. [PMID: 33242862 DOI: 10.1159/000509735] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/23/2020] [Indexed: 11/19/2022] Open
Abstract
Obesity is becoming more and more prevalent especially in Western industrial nations. The understanding of adipose tissue as an endocrine organ as well as the detection of adipocytokines - hormones that are secreted from the adipose tissue - gave reason to examine the interactions between adipose tissue and target organs. These efforts have been intensified especially in the context of bariatric surgery as promising weight loss therapy. Interactions between the lung and adipose tissue have rarely been investigated and are not well understood. There are obvious mechanical effects of obesity on lung function explaining the associations between obesity and lung diseases, in particular obesity hypoventilation syndrome, obstructive sleep apnea syndrome, asthma, and chronic obstructive pulmonary disease. The rise in the prevalence of obesity affects the epidemiology of pulmonary diseases as well. The aim of this review is to summarize the current knowledge on interactions, associations, and consequences of obesity and weight loss on lung function and lung diseases. Based on these data, areas for future research are identified.
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Affiliation(s)
- Judith Maria Brock
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany,
| | - Adrian Billeter
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Beat Peter Müller-Stich
- Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany
| | - Felix Herth
- Department of Pneumology and Critical Care Medicine, Thoraxklinik and Translational Lung Research Center Heidelberg (TLRCH), University of Heidelberg, Heidelberg, Germany
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Mohd Nasir AAB, Ban AYL, Syed Zakaria SZ, Nik Mahmood NRK, Abdul Hamid MF. A single tertiary centre outlook on the short-term outcome of bariatric surgery in improving pulmonary parameters and sleep apnoea. PROCEEDINGS OF SINGAPORE HEALTHCARE 2020. [DOI: 10.1177/2010105820948533] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Obesity is associated with obstructive sleep apnoea (OSA). Weight loss is an effective treatment. Bariatric surgery for obese, symptomatic OSA patients results in weight loss and improvement in lung function and sleep apnoea. This study aimed to determine the effectiveness of bariatric surgery in improving the respiratory mechanics and sleep apnoea using a lung function test and sleep study. Methods: A prospective study was conducted at the Pusat Perubatan Universiti Kebangsaan Malaysia Medical Centre involving adults undergoing bariatric work-up, attending respiratory clinic or admitted for bariatric work-up. We included subjects with a body mass index (BMI) >35 kg/m2 and Apnoea–Hypopnoea Index (AHI) of >5 events/hour. Subjects were assessed at baseline and at 12±2 weeks post bariatric surgery using the following methods: a partial sleep study, lung function test, six-minute walk test (6MWT) and Epworth Sleepiness Scale (ESS) score. Results: Twelve subjects were analysed. Their mean age was 36±5.7 years, and eight (67%) were female. The baseline mean AHI was 24.75±9.51 events/hour, the nadir mean oxygen saturation during sleep (SpO2) was 83.6±3.8%, the mean ESS score was 16±4, the mean forced expiratory volume in one second (FEV1) was 2.66±0.35 L, the mean forced vital capacity (FVC) was 3.23±0.45 L, the mean total lung capacity (TLC) was 4.97±1.19 L, the mean expiratory reserve volume (ERV) was 0.5±0.46 L, the mean residual volume (RV) was 1.46±0.91 L, the mean adjusted diffusing lung capacity for carbon monoxide (DLCO Adj) was 22.71±5.22 mL/mmHg/min, the mean adjusted diffusing lung capacity corrected for alveolar volume (DLVA Adj) was 5.61±0.90 mL/mmHg/min and the mean 6MWT was 293±49 m. Post surgery (12±2 weeks), the mean BMI decreased from 45.5 kg/m2 to 39.7 kg/m2, with a clinically significant improvement in AHI, ESS score, nadir SpO2, FEV1, FVC, TLC, ERV, RV, DLCO Adj, DLVA Adj and 6MWT ( p<0.05). Conclusion: Bariatric surgery improves sleep apnoea and lung function and reduces daytime somnolence.
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Affiliation(s)
| | - Andrea Yu-Lin Ban
- Respiratory Unit, Department of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Malaysia
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10
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Guguen C, Launois C, Dormoy V, Dewolf M, Dumazet A, Dury S, Lebargy F, Deslee G, Perotin JM. [Obesity and asthma: Mechanisms and therapeutic options]. Rev Mal Respir 2019; 37:134-143. [PMID: 31864881 DOI: 10.1016/j.rmr.2019.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 03/06/2019] [Indexed: 12/22/2022]
Abstract
Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.
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Affiliation(s)
- C Guguen
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - C Launois
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - V Dormoy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - M Dewolf
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - A Dumazet
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - S Dury
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - F Lebargy
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - G Deslee
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France
| | - J-M Perotin
- Service des maladies respiratoires, Inserm UMR-S 1250, CHU de Reims, 45, rue Cognacq-Jay, 51100 Reims, France.
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Betancourt-Peña J, Benavides-Córdoba V, Avila-Valencia JC, Rosero-Carvajal HE. Differences Between COPD Patients of a Pulmonary Rehabilitation Program According to the mMRC Dyspnea Scale. CURRENT RESPIRATORY MEDICINE REVIEWS 2019. [DOI: 10.2174/1573398x15666190404150703] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Background:
The modified Medical Research Council scale (mMRC) is a standardized
measure of the effect of dyspnea on the activities of the daily life of patients suffering from Chronic
Obstructive Pulmonary Disease (COPD). The aim of this study was to determine the differences in
the quality of life, tolerance to effort and symptoms among patients with COPD with lower (mMRC
0-1) and greater symptoms (mMRC ≥2).
Methods:
Cross-sectional study that included patients admitted to a pulmonary rehabilitation program
and who were classified into 2 groups: a group containing the less symptomatic patients and another
group with the more symptomatic ones. We collected these patients’ sociodemographic, clinical,
anthropometric, anxiety, depression and quality of life (SGRQ) data. Likewise, the subjects performed
the 6-minute walk test (6MWT). Finally, we measured the multidimensional BODE index score.
Results:
130 subjects were included, 35 presenting an mMRC of 0 to1 and 95 having an mMRC ≥ 2,
with an age of 70.87 ± 9.45 years old. The 6MWT distance, the VO2e, the total score of SGRQ, and
its domains of activities and impact showed significant differences between the groups (p <0.05).
Significant correlations were found in the group presenting an mMRC of 0-1 between the mMRC
and the FEV1 (p = 0.028), and in the group with an mMRC ≥2 for the FVC (p = 0.031), the 6MWT
distance (p = 0.000), the VO2e (p = 0.010) and the BODE index (p = 0.000).
Conclusion:
Patients with an mMRC of 0 to1 had better results in the 6MWT, the VO2e and the
SGRQ in comparison with the most symptomatic ones.
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Affiliation(s)
- Jhonatan Betancourt-Peña
- Cardioprevent, Universidad del Valle, Institucion Universitaria Escuela Nacional del Deporte, Health and Rehabilitation Faculty, Cali, Colombia
| | - Vicente Benavides-Córdoba
- Centro de Estudios Cerebrales Universidad del Valle, Institucion Universitaria Escuela Nacional del Deporte, Health and Rehabilitation Faculty, Cali, Colombia
| | - Juan Carlos Avila-Valencia
- Universidad Santiago de Cali, Clinica de Occidente, Institución Universitaria Escuela Nacional del Deporte, Health and Rehabilitation Faculty, Cali, Colombia
| | - Hamilton Elias Rosero-Carvajal
- Hospital Universitario del Valle, Grupo de Investigacion Ejercicio y Salud Cardiopulmonar Universidad del Valle, Institucion Universitaria Escuela Nacional del Deporte, Health and Rehabilitation Faculty, Cali, Colombia
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Ekström MP, Blomberg A, Bergström G, Brandberg J, Caidahl K, Engström G, Engvall J, Eriksson M, Gränsbo K, Hansen T, Jernberg T, Nilsson L, Nilsson U, Olin AC, Persson L, Rosengren A, Sandelin M, Sköld M, Sundström J, Swahn E, Söderberg S, Tanash HA, Torén K, Östgren CJ, Lindberg E. The association of body mass index, weight gain and central obesity with activity-related breathlessness: the Swedish Cardiopulmonary Bioimage Study. Thorax 2019; 74:958-964. [DOI: 10.1136/thoraxjnl-2019-213349] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Revised: 07/31/2019] [Accepted: 08/05/2019] [Indexed: 11/03/2022]
Abstract
IntroductionBreathlessness is common in the population, especially in women and associated with adverse health outcomes. Obesity (body mass index (BMI) >30 kg/m2) is rapidly increasing globally and its impact on breathlessness is unclear.MethodsThis population-based study aimed primarily to evaluate the association of current BMI and self-reported change in BMI since age 20 with breathlessness (modified Research Council score ≥1) in the middle-aged population. Secondary aims were to evaluate factors that contribute to breathlessness in obesity, including the interaction with spirometric lung volume and sex.ResultsWe included 13 437 individuals; mean age 57.5 years; 52.5% women; mean BMI 26.8 (SD 4.3); mean BMI increase since age 20 was 5.0 kg/m2; and 1283 (9.6%) reported breathlessness. Obesity was strongly associated with increased breathlessness, OR 3.54 (95% CI, 3.03 to 4.13) independent of age, sex, smoking, airflow obstruction, exercise level and the presence of comorbidities. The association between BMI and breathlessness was modified by lung volume; the increase in breathlessness prevalence with higher BMI was steeper for individuals with lower forced vital capacity (FVC). The higher breathlessness prevalence in obese women than men (27.4% vs 12.5%; p<0.001) was related to their lower FVC. Irrespective of current BMI and confounders, individuals who had increased in BMI since age 20 had more breathlessness.ConclusionBreathlessness is independently associated with obesity and with weight gain in adult life, and the association is stronger for individuals with lower lung volumes.
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Mainra A, Abdallah SJ, Reid RE, Andersen RE, Jensen D. Effect of weight loss via bariatric surgery for class III obesity on exertional breathlessness. Respir Physiol Neurobiol 2019; 266:130-137. [DOI: 10.1016/j.resp.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Revised: 05/03/2019] [Accepted: 05/11/2019] [Indexed: 12/19/2022]
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Lessa T, Pereira CADC, Soares MR, Matos R, Guimarães VP, Sanches G, Rassi RH, Maia I. Reference values for pulmonary volumes by plethysmography in a Brazilian sample of white adults. J Bras Pneumol 2019; 45:e20180065. [PMID: 31166555 PMCID: PMC6715037 DOI: 10.1590/1806-3713/e20180065] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Accepted: 09/23/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To derive reference values for healthy white Brazilian adults who have never smoked and to compare the obtained values with reference values derived by Crapo and by Neder. METHODS Reference equations by quantile regressions were derived in 122 men and 122 women, non-obese, living in seven cities in Brazil. Age ranged from 21 to 92 years in women and from 25 to 88 years in men. Lung function tests were performed using SensorMedics automated body plethysmographies according ATS/ERS recommendations. Lower and upper limits were derived by specific equations for 5 and 95 percentiles. The results were compared to those suggested by Crapo in 1982, and Neder in 1999. RESULTS Median values for total lung capacity (TLC) were influenced only by stature in men, and by stature and age in women. Residual volume was influenced by age and stature in both genders. Weight was directly related to inspiratory capacity and inversely with functional residual capacity and expiratory reserve volume in both genders. A comparison of observed TLC data with values predicted by Neder equations showed significant lower values by the present data. Mean values were similar between data from present study and those derived by Crapo. CONCLUSION New predicted values for lung volumes were obtained in a sample of white Brazilians. The values differ from those derived by Neder, but are similar to those derived by Crapo.
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Affiliation(s)
- Thamine Lessa
- . Laboratório de Função Pulmonar, Clínica AMO - Assistência Multidisciplinar em Oncologia, Salvador (BA) Brasil
| | | | - Maria Raquel Soares
- . Laboratório de Função Pulmonar, Centro Diagnóstico Brasil, São Paulo (SP) Brasil
| | - Renato Matos
- . Pneuma - Medicina Respiratória, Criciúma (SC) Brasil
| | | | | | | | - Israel Maia
- . Laboratório de Função Pulmonar da Clínica Tórax, Florianópolis (SC) Brasil
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Fontana AD, Lopes AD, Lunardi AC. Bariatric Surgery Associated with Practice of Moderate to Intense Physical Activity Related to Weight Loss, Activity Level in Daily Life, Dyspnea, and Quality of Life of Sedentary Individuals with Morbid Obesity: a Prospective Longitudinal Study. Obes Surg 2019; 29:2442-2448. [DOI: 10.1007/s11695-019-03859-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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