Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR and UPLIFT

Abstract

Rationale There is an association between body mass index (BMI) and mortality in chronic obstructive pulmonary disease (COPD), with underweight individuals having higher mortality risk. Mortality and exacerbation risks among individuals with higher BMI are unclear. Objectives To examine the relationship between BMI and adverse outcomes in COPD. Methods This post hoc analysis included data from TIOSPIR (Tiotropium Safety and Performance in Respimat) ( N = 17,116) and tiotropium-treated patients in UPLIFT (Understanding Potential Long-term Impacts on Function with Tiotropium) ( N = 2,986). BMI classes (underweight [BMI < 20 kg/m 2 ], normal weight [BMI 20 to <25 kg/m 2 ], overweight [BMI 25 to <30 kg/m 2 ], obesity class I [BMI 30 to <35 kg/m 2 ], obesity class II [BMI 35 to <40 kg/m 2 ], and obesity class III [BMI ⩾ 40 kg/m 2 ]) were examined for adjusted associations with mortality, exacerbation, and nonfatal cardiovascular event risk using over 50,000 patient-years of cumulative follow-up data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models. Results In TIOSPIR, obesity prevalence was 22%, overweight 32%, and underweight 12%. The proportion of females was highest in obesity classes II and III. Overweight and obese participants had better baseline lung function versus other BMI classes; underweight participants were more likely to be current smokers. Underweight participants had a significantly higher risk of death (HR, 1.88; 95% CI, 1.62–2.20; P < 0.0001) and severe exacerbations (HR, 1.31; 95% CI, 1.16–1.47; P < 0.0001) versus normal-weight participants; however, overweight and obese participants were at lower to no additional risk. Results from UPLIFT were similar to TIOSPIR. Conclusions These results suggest that there is a strong association between body weight, COPD events, and risk of death. A holistic management approach taking into account respiratory and cardiovascular risk factors and nutritional status is needed to improve the general well-being of patients with COPD.

WITHDRAWN: The clinical characteristics and treatment response of patients with chronic obstructive pulmonary disease with low body mass index

“…Therefore, it is necessary to explore the relationship between exacerbation, mortality, symptoms improved or deteriorated and clinical characteristics including BMI in COPD patients. In fact, several studies have been demonstrated that the patients with low BMI had a higher future risk of exacerbation and mortality [2][3][4][5][6]8]. In this study, we also found that low BMI patients had a higher future risk of hospitalizations and mortality during one year of follow up.…”

“…This might be associate with the social economic conditions in the previous year in China. In addition, Putcha et al [3] found that baseline FEV1%pred and FEV1/FVC were lower in low BMI groups. In our study, we also found that the low BMI had a worse pulmonary function.…”

“…In fact, the BMI plays an important role in the pathophysiology of COPD and it is an independent prognostic factor for mortality and disease severity of COPD [2]. Putcha, et al [3] studies showed that the COPD patients with low BMI (< 20 kg/m 2 ) had a worse pulmonary function, higher risk of future severe exacerbation and mortality. In addition, low BMI (< 20 kg/m 2 ) was associated with higher risk of rst acute COPD admission [4].…”

“…Currently, long-term pharmacological including long-acting muscarinic antagonist (LAMA), long-acting β2-agonist (LABA) + inhaled corticosteroid (ICS), LABA + LAMA and LABA + LAMA + ICS were the rst choice for the treatment of stable COPD patients [7]. In fact, most previous studies were focus on the relationship between BMI and risk of exacerbation and mortality [2][3][4][5][6]8]. None of studies focus on the relationship between BMI and symptoms improved or deteriorated.…”

Clinical–functional characteristics and risk of exacerbation and mortality among more symptomatic patients with chronic obstructive pulmonary disease: a retrospective cohort study

“…In addition, our research results show that more symptomatic patients had a lower BMI but a higher risk of future exacerbation and mortality. This was consistent with a study by Putcha et al , 35 which showed that underweight participants had a significantly higher risk of death and severe exacerbation.…”