Characterization of Self-reported Asthma in Morbidly Obese Women
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Characterization of Self-reported Asthma in Morbidly Obese Women
Presented By: Alton R. Johnson Jr.
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Outline Asthma
Pathophysiology, epidemiology, & diagnosis
Obesity Definition, trends, morbidity
Obesity & asthma association Supporting evidence
Summer Research Project
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Pathophysiology Asthma
Inflammation
Airway Hyperresponsiveness
Airway Obstruction
Clinical symptoms
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Epidemology of asthma One of the most common chronic
respiratory diseases affects approx. 7% of population (22
million) (CDC, 2010)▪ 27% are children (>6 million) (CDC, 2010)
Associated with significant morbidity▪ African American children have a 250%
higher hospitalization rate and a 500% higher death rate (CDC, 2010)
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Asthma: Prevalence Prevalence = (# of people with the disease) / (# of people
at risk for disease + # of people with the disease) Increasing prevalence over past 20 years (NAEPP, 2010) Significant disparity.
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Obesity
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Obesity Trends* Among U.S. AdultsBRFSS, 1990, 2008
(*BMI 30, or about 30 lbs. overweight for 5’4” person)
20081990
No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%
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Obesity and Asthma
Cross-sectional studies Increased prevalence of asthma in obese
patients Obesity associated with worst asthma control
and increased morbidity (severe symptoms)
Longitudinal studies Asthma risk increases by 50 % in overweight
and obese people AHR is associated with increased BMI
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Obesity associated with increased risk of asthma
Beuther and Sutherland 2007
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Obesity and Asthma Possible explanations:
Causal link▪ Obesity leads to increased risk of asthma▪ Inflammatory pathway▪Mechanical pathway
Coincidental▪ Epiphenomenon▪ Shared risk factors (i.e. genetic, environmental)
Diagnostic bias
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Effects of obesity on asthma control/severity
Controversial findings Some studies showing worst asthma
symptoms in obese patients (Schacter et.al. 2001)
Others have not (Clerisme-Beaty et.al. 2009) Limited by use of self-report or
questionnaire to diagnose asthma
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Obesity is associated with changes in lung volumes which may mimic asthma.
It is unclear whether the asthma phenotype is different in obese patients
Project Importance
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To examine differences in pulmonary function profile, respiratory symptoms, and quality of life in morbidly obese women based on self-reported asthma.
Objective
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53 participants were recruited to participate in the study. 11 were excluded based on gender, leaving 42 women in the final analysis.
Recruitment
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Results
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Baseline Demographics
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General Health Survey Results
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Respiratory Questionnaire
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Pulmonary Function Profile
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Air Hyperresponsiveness
24 participants (6 asthmatics, 18 non-asthmatics) 60% asthmatics had positive AHR
40% non-asthmatics had positive AHR
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Conclusions Both Groups:
Decreased quality of life Increased reports of respiratory symptoms Trend for lower FEV1/FVC
Asthmatics: Significantly more respiratory complaints Lower quality of life
Symptoms rather than objective differences in respiratory function may guide the diagnosis of asthma in this population
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Limitation
It is unclear whether these findings apply to men or patients with less severe obesity.
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Acknowledgements Emmanuelle Clerisme-Beaty, MD MHS Mercedes Proctor, BA Andrew Bilderback, MS Cynthia Rand, PhD Flona Redway, PhD Denise Guise
Funding: NIH/NHLBI grant R25 HL084762, Johns Hopkins
University NIH grant K12RR01767, Johns Hopkins University NIH-NIGMS RISE Grant, R25 GM059244-09, Barry
University
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Questions