The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 207-212, August 2009

Does higher body mass index contribute to worse asthma control in an urban population?

  • Emmanuelle M. Clerisme-Beaty, MD, MHS

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, Md
    • These authors contributed equally to this work.
    • ,
  • Sabine Karam, MD

      Affiliations

    • Department of Medicine, Albert Einstein College of Medicine, New York, NY
    • These authors contributed equally to this work.
    • ,
  • Cynthia Rand, PhD

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, Md
    • ,
  • Cecilia M. Patino, MD

      Affiliations

    • Department of Preventive Medicine, University of Southern California, Los Angeles, Calif
    • ,
  • Andrew Bilderback, MS

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, Md
    • ,
  • Kristin A. Riekert, PhD

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, Md
    • ,
  • Sande O. Okelo, MD

      Affiliations

    • Department of Pediatrics, Johns Hopkins University, Baltimore, Md
    • ,
  • Gregory B. Diette, MD, MHS

      Affiliations

    • Department of Medicine, Johns Hopkins University, Baltimore, Md
    • Corresponding Author InformationReprint requests: Gregory B. Diette, MD, MHS, Division of Pulmonary Critical Care Medicine, 1830 E Monument St, Fifth Floor, Baltimore, MD 21205.

Received 19 December 2008; received in revised form 12 May 2009; accepted 15 May 2009. published online 17 July 2009.

Background

Epidemiologic findings support a positive association between asthma and obesity.

Objective

Determine whether obesity or increasing level of body mass index (BMI) are associated with worse asthma control in an ethnically diverse urban population.

Methods

Cross-sectional assessment of asthma control was performed in patients with asthma recruited from primary care offices by using 4 different validated asthma control questionnaires: the Asthma Control and Communication Instrument (ACCI), the Asthma Control Test (ACT), the Asthma Control Questionnaire (ACQ), and the Asthma Therapy Assessment Questionnaire (ATAQ). Multiple linear regression analysis was performed to evaluate the association between obesity and increasing BMI level and asthma control.

Results

Of 292 subjects with a mean age of 47 years, the majority were women (82%) and African American (67%). There was a high prevalence of obesity with 63%, with only 15% normal weight. The mean score from all 4 questionnaires showed an average suboptimal asthma control (mean score/maximum possible score): ACCI (8.3/19), ACT (15.4/ 25), ACQ (2.1/ 6), and ATAQ (1.3/ 4). Regression analysis showed no association between obesity or increasing BMI level and asthma control using all 4 questionnaires. This finding persisted even after adjusting for FEV1, smoking status, race, sex, selected comorbid illnesses, and long-term asthma controller use.

Conclusion

Using 4 validated asthma control questionnaires, we failed to find an association between obesity and asthma control in an urban population with asthma. Weight loss may not be an appropriate strategy to improve asthma control in this population.

Key words: Asthma, asthma control, obesity, overweight, body mass index, inner city, asthma communication control instrument, ACCI, African American

Abbreviations used: ACCI, Asthma Control and Communication Instrument, ACQ, Asthma Control Questionnaire, ACT, Asthma Control Test, ATAQ, Asthma Therapy Assessment Questionnaire, BMI, Body mass index, FVC, Forced vital capacity, GERD, Gastroesophageal reflux disease, IQR, Interquartile range

 

 Supported by National Heart, Lung, and Blood Institute grant 5UO1HL072455 and National Institutes of Health grant K12 RR017627.

 Disclosure of potential conflict of interest: C. Rand is a consultant for Schering-Plough and the Merck Foundation. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00858-6

doi:10.1016/j.jaci.2009.05.034

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 207-212, August 2009

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