Cross-Sectional Assessment of the Roles of Comorbidities in Resting and Activity-Related Dyspnea in Severely Obese Women

Abstract

Objectives. Obesity has been associated with a lesser degree of asthma control that may be biased by other comorbidities. The objectives of this cross-sectional study were to describe resting and activity-related dyspnea complaints according to the presence of obesity-related comorbidities (asymptomatic airway hyperresponsiveness (AHR), asthma, gastroesophageal reflux disease (GERD) and sleep-disordered breathing (SDB)). We hypothesized that obese women can exhibit both resting and activity-related dyspnea, independently of the presence of asthma. Methods. Severely obese (body mass index (BMI) > 35 kg m⁻²) women prospectively underwent description of resting and activity-related dyspnea (verbal descriptors and Medical Research Council (MRC) scale), pulmonary function testing (spirometry, absolute lung volumes, and methacholine challenge test), oesogastro-duodenal fibroscopy, and overnight polygraphy. Thirty healthy lean women without airway hyperresponsiveness were enrolled. Results. Resting dyspnea complaints were significantly more prevalent in obesity (prevalence 41%) than in healthy lean women (prevalence 3%). Chest tightness and the need for deep inspirations were independently associated with both asthma and GERD while wheezing and cough were related to asthma only in obese women. Activity-related dyspnea was very prevalent (MRC score > 1, 75%), associated with obesity, with the exception of wheezing on exertion due to asthma. Asymptomatic AHR and SDB did not affect dyspneic complaints. Conclusions. In severely obese women referred for bariatric surgery, resting dyspnea complaints are observed in association with asthma or GERD, while activity-related dyspnea was mainly related to obesity only. Consequently, asthma does not explain all respiratory complaints of obese women.

• airway responsiveness
• asthma
• gastroesophageal reflux disease
• obesity
• pulmonary function tests
• sleep-disordered breathing

Acknowledgments

The authors wish to thank the technicians of the pulmonary function laboratory for their expert assistance (Martine Riquelme, Françoise LeBihan, Mireille Morot, and Marien Bokouabassa), the different contributors from the Unité de Recherche Clinique of the Hôpital européen Georges Pompidou (Gilles Chatellier [medical coordinator], Noël Lucas [medical coordinator], Yann Guivarch [financial account manager], Chantal Andrieux [clinical trial coordinator], and Jean-François Leforestier [data manager]), the Département d’Informatique Médicale (Abden Naji El Fadly for merging the databases and Christel Daniel for supervision [RE-USE project]), the Centre d’Investigations Cliniques (recruitment of healthy subjects, Dr. Anne Blanchard), and the Direction de la Recherche Clinique et du Développement (DRCD of AP-HP: Mathieu Quintin) for sponsoring.

The authors also thank Prof. Urs Frey for his detailed comments for VT variability analysis.

Declaration of Interests

The authors declare no competing interest. This governmental organization had no direct financial interest in the subject discussed in the submitted manuscript.

This study was funded by a grant from the Assistance Publique - Hôpitaux de Paris (AP-HP: Direction de la Recherche Clinique et du Développement: Contrat d’Initiation à la Recherche Clinique P061010). The Unité de Recherche Clinique was responsible for independent data monitoring and analysis under the supervision of our funder (Assistance Publique – Hôpitaux de Paris; project code: P061010, Breathing Obesity Asthma, BOA study).