Impact of Obesity on the Severity and Therapeutic Responsiveness of Acute Episodes of Asthma

Abstract

Background. It has been suggested that obesity adversely influences both the severity and the therapeutic responsiveness of chronic asthma. However, it is unclear if it also impacts acute situations. Methods. To determine whether adiposity worsens the clinical and physiological manifestations of acute asthma and limits therapeutic effectiveness of standard treatment, we contrasted signs, symptoms, medication use, arterial oxygen saturation, peak expiratory flow rate, and the bronchodilator response to standard doses of albuterol in 90 non-obese and 90 obese asthmatics as they presented for urgent care. Treatment and clinical decisions were systematized using published care paths and the peak flow was measured with standard techniques. Body mass index (BMI) was calculated according to consensus criteria. Results. Other than BMI (p < .001), there were no between-group differences in age, gender, race, signs, symptoms, pulse oximetry, or pre-presentation medication use. The pretreatment peak flow in the obese population was 22.4% higher on average (p = .007), but there were no differences in the distribution of severity (p = .38), the response to albuterol (p = .61), or admission–discharge ratios (p = .62). Conclusions. Obesity does not adversely influence the severity or the resolution of acute episodes of asthma.

Keywords:

• acute asthma attacks
• albuterol
• asthma
• asthma treatment
• obesity

Acknowledgments

Supported in part by Grant HL33791 and HL04140 from the National Heart, Lung, and Blood Institute, United States Public Health Services. Dr. McFadden has received grants from NIH and has served as a reviewer for NHLBI and NAID. He is currently the principal investigator on an investigator-initiated study supported by GlaxoSmithKline that deals with the genetics of B₂ adrenergic receptors in acutely ill asthmatics who fail emergency therapy with albuterol. He has also received honorarium from MERCK.

Declaration of Interest

The authors report no conflicts of interests. The authors alone are responsible for the content and writing of this article.