Abstract
Background: Asthma is defined by variable respiratory symptoms and lung function, and may influence work ability. Similarly, obesity may contribute to respiratory symptoms, affect lung function, and reduce work ability. Thus, assessment of the influence of obesity on work ability, respiratory symptoms, and lung function in adults with asthma is needed. Objectives: We hypothesized that patients with obesity and asthma have more respiratory symptoms and reduced work ability and lung function compared with normal-weight patients with asthma. Methods: We examined 626 participants with physician-diagnosed asthma, aged 18–52 years, recruited from a cross-sectional general population study using a comprehensive questionnaire including work ability score, the asthma control test (ACT), height and weight, and spirometry with reversibility testing. Results: Participants with a body mass index (BMI) ≥30 kg/m2 (i.e., obese) had a higher symptom score (OR 1.78, 95% CI 1.14–2.80), current use of asthma medication (1.60, 1.05–2.46), and incidence of ACT scores ≤19 (poor asthma control) (1.81, 1.03–3.18) than participants with BMI ≤24.9 kg/m2 (i.e., normal weight). Post-bronchodilator forced vital capacity (FVC) as a percentage of predicted (β coefficient –4.5) and pre-bronchodilator forced expiratory volume in 1 s as a percentage of predicted (FEV1) (β coefficient –4.6) were negatively associated with BMI ≥30 kg/m2. We found no statistically significant association of BMI >30 kg/m2 (compared to BMI <24.9 kg/m2) with sick leave (1.21, 0.75–1.70) or reduced work ability (1.23, 0.74–2.04). Conclusions: There were indications that patients with obesity had a higher symptom burden, poorer asthma control, higher consumption of asthma medication, and reduced lung function, in particular for FVC, compared with normal-weight patients.
References
1.
The Global Asthma Report 2018, Global Asthma Network.
2.
World Health Organisation Fact Sheets; Obesity and overweight, 2017.
3.
Moore
WC
, Meyers
DA
, Wenzel
SE
, Teague
WG
, Li
H
, Li
X
, et al; National Heart, Lung, and Blood Institute’s Severe Asthma Research Program
. Identification of asthma phenotypes using cluster analysis in the Severe Asthma Research Program
. Am J Respir Crit Care Med
. 2010
Feb
;181
(4
):315
–23
.
[PubMed]
1073-449X4.
Haldar
P
, Pavord
ID
, Shaw
DE
, Berry
MA
, Thomas
M
, Brightling
CE
, et al Cluster analysis and clinical asthma phenotypes
. Am J Respir Crit Care Med
. 2008
Aug
;178
(3
):218
–24
.
[PubMed]
1073-449X5.
Wenzel
SE
. Asthma phenotypes: the evolution from clinical to molecular approaches
. Nat Med
. 2012
May
;18
(5
):716
–25
.
[PubMed]
1078-89566.
Zammit
C
, Liddicoat
H
, Moonsie
I
, Makker
H
. Obesity and respiratory diseases
. Int J Gen Med
. 2010
Oct
;3
:335
–43
.
[PubMed]
1178-70747.
Taylor
B
, Mannino
D
, Brown
C
, Crocker
D
, Twum-Baah
N
, Holguin
F
. Body mass index and asthma severity in the National Asthma Survey
. Thorax
. 2008
Jan
;63
(1
):14
–20
.
[PubMed]
0040-63768.
Bildstrup
L
, Backer
V
, Thomsen
SF
. Increased body mass index predicts severity of asthma symptoms but not objective asthma traits in a large sample of asthmatics
. J Asthma
. 2015
Sep
;52
(7
):687
–92
.
[PubMed]
0277-09039.
Cockcroft
DW
, Swystun
VA
. Asthma control versus asthma severity
. J Allergy Clin Immunol
. 1996
Dec
;98
(6 Pt 1
):1016
–8
.
[PubMed]
0091-674910.
Humbert
M
, Holgate
S
, Boulet
LP
, Bousquet
J
. Asthma control or severity: that is the question
. Allergy
. 2007
Feb
;62
(2
):95
–101
.
[PubMed]
0105-453811.
Taylor
DR
, Bateman
ED
, Boulet
LP
, Boushey
HA
, Busse
WW
, Casale
TB
, et al A new perspective on concepts of asthma severity and control
. Eur Respir J
. 2008
Sep
;32
(3
):545
–54
.
[PubMed]
0903-193612.
Schatz
M
, Mosen
DM
, Kosinski
M
, Vollmer
WM
, Magid
DJ
, O’Connor
E
, et al Predictors of asthma control in a random sample of asthmatic patients
. J Asthma
. 2007
May
;44
(4
):341
–5
.
[PubMed]
0277-090313.
Andersen
LL
, Izquierdo
M
, Sundstrup
E
. Overweight and obesity are progressively associated with lower work ability in the general working population: cross-sectional study among 10,000 adults
. Int Arch Occup Environ Health
. 2017
Nov
;90
(8
):779
–87
.
[PubMed]
0340-013114.
Lindström
I
, Pallasaho
P
, Luukkonen
R
, Suojalehto
H
, Karjalainen
J
, Lauerma
A
, et al Reduced work ability in middle-aged men with asthma from youth—a 20-year follow-up
. Respir Med
. 2011
Jun
;105
(6
):950
–5
.
[PubMed]
0954-611115.
Abrahamsen
R
, Fell
AK
, Svendsen
MV
, Andersson
E
, Torén
K
, Henneberger
PK
, et al Association of respiratory symptoms and asthma with occupational exposures: findings from a population-based cross-sectional survey in Telemark, Norway
. BMJ Open
. 2017
Mar
;7
(3
):e014018
.
[PubMed]
2044-605516.
Abrahamsen
R
, Svendsen
MV
, Henneberger
PK
, Gundersen
GF
, Torén
K
, Kongerud
J
, et al Non-response in a cross-sectional study of respiratory health in Norway
. BMJ Open
. 2016
Jan
;6
(1
):e009912
.
[PubMed]
2044-605517.
Torén
K
, Ekerljung
L
, Kim
JL
, Hillström
J
, Wennergren
G
, Rönmark
E
, et al Adult-onset asthma in west Sweden—incidence, sex differences and impact of occupational exposures
. Respir Med
. 2011
Nov
;105
(11
):1622
–8
.
[PubMed]
0954-611118.
Nathan
RA
, Sorkness
CA
, Kosinski
M
, Schatz
M
, Li
JT
, Marcus
P
, et al Development of the asthma control test: a survey for assessing asthma control
. J Allergy Clin Immunol
. 2004
Jan
;113
(1
):59
–65
.
[PubMed]
0091-674919.
American Thoracic Society
European Respiratory Society
. ATS/ERS recommendations for standardized procedures for the online and offline measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide, 2005
. Am J Respir Crit Care Med
. 2005
Apr
;171
(8
):912
–30
.
[PubMed]
1073-449X20.
Miller
MR
, Hankinson
J
, Brusasco
V
, Burgos
F
, Casaburi
R
, Coates
A
, et al; ATS/ERS Task Force
. Standardisation of spirometry
. Eur Respir J
. 2005
Aug
;26
(2
):319
–38
.
[PubMed]
0903-193621.
Quanjer
PH
, Stanojevic
S
, Cole
TJ
, Baur
X
, Hall
GL
, Culver
BH
, et al; ERS Global Lung Function Initiative
. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations
. Eur Respir J
. 2012
Dec
;40
(6
):1324
–43
.
[PubMed]
0903-193622.
Pellegrino
R
, Viegi
G
, Brusasco
V
, Crapo
RO
, Burgos
F
, Casaburi
R
, et al Interpretative strategies for lung function tests
. Eur Respir J
. 2005
Nov
;26
(5
):948
–68
.
[PubMed]
0903-193623.
Gould RI, Järvisalo J, Koskinen S. Dimensisons of work ability. Results from the 2000 survey. Helsinki: Finnish Centre for Pensions; 2008.
24.
Gould
RI
, Järvisalo
J
, Koskinen
S
. Dimensisons of work ability. Results from the 2000 survey.: Helsinki 2008, Finnish Centre for Pensions, 2008, Ahlstrom L, Grimby-Ekman A, Hagberg M, Dellve L: The work ability index and single-item question: associations with sick leave, symptoms, and health—a prospective study of women on long-term sick leave
. Scand J Work Environ Health
. 2010
;36
:404
–12
.0355-314025.
El Fassi
M
, Bocquet
V
, Majery
N
, Lair
ML
, Couffignal
S
, Mairiaux
P
. Work ability assessment in a worker population: comparison and determinants of Work Ability Index and Work Ability score
. BMC Public Health
. 2013
Apr
;13
(1
):305
.
[PubMed]
1471-245826.
Kwon
JW
, Kim
SH
, Kim
TB
, Kim
SH
, Park
HW
, Chang
YS
, et al Airway hyperresponsiveness is negatively associated with obesity or overweight status in patients with asthma
. Int Arch Allergy Immunol
. 2012
;159
(2
):187
–93
.
[PubMed]
1018-243827.
Schachter
LM
, Salome
CM
, Peat
JK
, Woolcock
AJ
. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness
. Thorax
. 2001
Jan
;56
(1
):4
–8
.
[PubMed]
0040-637628.
Kasteleyn
MJ
, Bonten
TN
, de Mutsert
R
, Thijs
W
, Hiemstra
PS
, le Cessie
S
, et al Pulmonary function, exhaled nitric oxide and symptoms in asthma patients with obesity: a cross-sectional study
. Respir Res
. 2017
Dec
;18
(1
):205
.
[PubMed]
1465-992129.
Pisi
R
, Aiello
M
, Tzani
P
, Marangio
E
, Olivieri
D
, Pisi
G
, Chetta
A
: Overweight is associated with airflow obstruction and poor disease control but not with exhaled nitric oxide change in an asthmatic population.
Respiration; international review of thoracic diseases 2012
;84:416-422. 30.
Neovius
K
, Johansson
K
, Kark
M
, Neovius
M
. Obesity status and sick leave: a systematic review
. Obes Rev
. 2009
Jan
;10
(1
):17
–27
.
[PubMed]
1467-788131.
van Duijvenbode
DC
, Hoozemans
MJ
, van Poppel
MN
, Proper
KI
. The relationship between overweight and obesity, and sick leave: a systematic review
. Int J Obes
. 2009
Aug
;33
(8
):807
–16
.
[PubMed]
0307-056532.
Hansen
CL
, Baelum
J
, Skadhauge
L
, Thomsen
G
, Omland
Ø
, Thilsing
T
, et al Consequences of asthma on job absenteeism and job retention
. Scand J Public Health
. 2012
Jun
;40
(4
):377
–84
.
[PubMed]
1403-494833.
Kauppi
P
, Salo
P
, Hakola
R
, Pentti
J
, Oksanen
T
, Kivimäki
M
, et al Allergic rhinitis alone or with asthma is associated with an increased risk of sickness absences
. Respir Med
. 2010
Nov
;104
(11
):1654
–8
.
[PubMed]
0954-611134.
Nathell
L
, Jensen
I
, Larsson
K
. High prevalence of obesity in asthmatic patients on sick leave
. Respir Med
. 2002
Aug
;96
(8
):642
–50
.
[PubMed]
0954-611135.
Guerra
S
, Martinez
FD
. Epidemiology of the origins of airflow limitation in asthma
. Proc Am Thorac Soc
. 2009
Dec
;6
(8
):707
–11
.
[PubMed]
1546-322236.
Melo
LC
, Silva
MA
, Calles
AC
. Obesity and lung function: a systematic review
. Einstein (Sao Paulo)
. 2014
Jan-Mar
;12
(1
):120
–5
.
[PubMed]
1679-450837.
Littleton
SW
. Impact of obesity on respiratory function
. Respirology
. 2012
Jan
;17
(1
):43
–9
.
[PubMed]
1323-779938.
Mafort
TT
, Rufino
R
, Costa
CH
, Lopes
AJ
. Obesity: systemic and pulmonary complications, biochemical abnormalities, and impairment of lung function
. Multidiscip Respir Med
. 2016
Jul
;11
(1
):28
.
[PubMed]
1828-695X39.
Forno E, Han YY, Mullen J, Celedon JC. Overweight, Obesity, and Lung Function in Children and Adults-A Meta-analysis. J Allergy Clin Immunol Pract. 2018;6(2):570-581.e10.
40.
Forno
E
, Han
YY
, Mullen
J
, Celedon
JC
. Overweight, Obesity, and Lung Function in Children and Adults-A Meta-analysis. The journal of allergy and clinical immunology In practice 2018;6:570-581.e510. Ciprandi G, Schiavetti I, Bellezza Fontana R, Sorbello V, Ricciardolo FL: Overweight and obesity as risk factors for impaired lung function in patients with asthma: A real-life experience
. Allergy Asthma Proc
. 2014
;35
:e62
–71
.1088-541241.
Gibeon
D
, Batuwita
K
, Osmond
M
, Heaney
LG
, Brightling
CE
, Niven
R
, et al Obesity-associated severe asthma represents a distinct clinical phenotype: analysis of the British Thoracic Society Difficult Asthma Registry Patient cohort according to BMI
. Chest
. 2013
Feb
;143
(2
):406
–14
.
[PubMed]
0012-369242.
Statistics Norway, 2019, Norway, accessed June 6, 2019.
43.
Maukonen
M
, Männistö
S
, Tolonen
H
; Statistics Norway
. A comparison of measured versus self-reported anthropometrics for assessing obesity in adults: a literature review
. Scand J Public Health
. 2018
Jul
;46
(5
):565
–79
.
[PubMed]
1403-494844.
Torén
K
, Brisman
J
, Järvholm
B
. Asthma and asthma-like symptoms in adults assessed by questionnaires. A literature review
. Chest
. 1993
Aug
;104
(2
):600
–8
.
[PubMed]
0012-369245.
World Health Organization- Regional Office for Europe
. Body Mass Index - BMI, 2018
.© 2019 S. Karger AG, Basel
2019
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.
