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Chest. 2017 Jan;151(1):68-77. doi: 10.1016/j.chest.2016.08.1432. Epub 2016 Aug 25.

Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD.

Author information

1
Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. Electronic address: alamber5@jhmi.edu.
2
Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD.
3
Department of Medicine, Division of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX.
4
Department of Medicine, Division of Pulmonary and Critical Care, Temple University, Philadelphia, PA.
5
Department of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO.
6
Channing Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Abstract

BACKGROUND:

Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD.

METHODS:

We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2).

RESULTS:

Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations.

CONCLUSIONS:

Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.

KEYWORDS:

COPD; dose response; exacerbation; morbidity; obesity

PMID:
27568229
PMCID:
PMC5310126
DOI:
10.1016/j.chest.2016.08.1432
[Indexed for MEDLINE]
Free PMC Article

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