Discrepancies between asthma control criteria in asthmatic patients with and without obesity

Abstract

Objective To compare the prevalence of discrepancies between clinical, physiological, and inflammatory asthma control parameters between patients with asthma and obesity and patients with asthma but not obesity using the Asthma Control Scoring System (ACSS). Methods A retrospective analysis of demographic data and ACSS scores was performed in two groups of patients with asthma (74 with obesity and 74 without obesity) paired for sex, age, and asthma severity. Scores from each asthma control parameter—clinical (respiratory symptoms), physiological (forced expiratory volume in 1 s), and inflammatory (sputum eosinophil percentage)—were compared. Discrepancy was defined as a >20% difference between two scores. Results The prevalence of discrepancies between scores was similar between asthma patients with or without obesity. A sub‐analysis on patients with uncontrolled asthma (ACSS global score <80%) showed a higher prevalence of discrepancies between the clinical and physiological scores in subjects with obesity, the clinical score being higher than the physiological one in most (87%) cases. Conclusions Subjects with obesity and uncontrolled asthma show higher clinical scores than physiological scores, suggesting an under‐evaluation of asthma symptoms. Future studies are needed to evaluate the influence of obesity on each type of asthma symptom.

La obesidad en adultos está asociada con la gravedad del asma, pero no con el control del asma

“…Diversos estudios previos han dado cuenta de las variaciones en la función respiratoria que pueden ser apreciadas en la relación asma-obesidad. 5,6,7,8 Similarmente, cuando la gravedad del asma se estima a través de los lineamientos propuestos por GINA, los resultados son inconsistentes: en tanto algunos estudios dan cuenta de una asociación entre la obesidad y el asma, 9,10,11,12 otros tantos no lo hacen. 5,7,13 En resumen, con este estudio demostramos que los pacientes con asma y obesidad tienen un perfil de función pulmonar diferente al de su contraparte sin obesidad.…”

“…Uno de ellos implica la función respiratoria; sin embargo, hasta el momento, los hallazgos son inconsistentes, pues se han observado modificaciones en el volumen espiratorio forzado en el primer segundo (VEF 1 ), la capacidad vital forzada (CVF) la relación VEF 1 /CVF o en la combinación de ellos. 5,6,7,8 De la mano de este método, se realiza la categorización de la gravedad del asma de acuerdo con los lineamientos propuestos por Global Initiative for Asthma (GINA), pero de nueva cuenta, los resultados son discrepantes. 5,9.10,11,12,13 La gravedad del asma también puede ser determinada por la historia de hospitalizaciones por asma durante el año previo; en ese sentido, este elemento parece ser el más consistente, al no guardar asociación con la obesidad.…”

Asthma medication use in obese and healthy weight asthma: systematic review/meta-analysis

“…Of the 35 included studies, cross-sectional design [12,15,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] was most commonly used (n=19), followed by six retrospective cohort studies [43][44][45][46][47][48], six prospective cohort studies [49][50][51][52][53][54], three casecontrol studies [55][56][57] and one time-series study [58] (table 1). Included studies were published from 1999 to 2019.…”

“…Included studies were published from 1999 to 2019. Most studies were conducted in the United States of America (n=15) [12, 15, 26-28, 43-47, 49, 50, 54-56], with others from Europe (n=5) [29-31, 51, 52], Asia (n=4) [39][40][41][42], Canada (n=4) [32][33][34]48], Australia (n=2) [53,58], South America (n=2) [35,36], Africa [37], Central America [57] and New Zealand [38].…”

“…Of the 35 studies (table 1), the majority (74%) reported ICS use (n=26) [12, 15, 27, 28, 31-33, 35, 38-40, 42-48, 50, 52-58]. The second most reported asthma medication (46% of studies) included OCS (n=16) [12, 15, 27-31, 33, 36, 39, 40, 44, 48, 49, 51, 52], subgrouped into maintenance OCS use (n=10) (29% of studies) [12,28,30,33,39,40,44,48,51,52] and recue OCS use (n=6) (17% of studies) [15,27,29,31,36,49]. 31% reported LTRA use (n=11) [12,15,28,32,33,39,42,44,47,51,56] and 29% reported LABA use (n=10) [12,15,29,32,33,42,44,52,56,58].…”