哮喘联盟

   摘要
   背景：虽然研究一致表明肥胖和哮喘发生率的增加存在相关性，但是肥胖在哮喘控制方面所发挥的作用并不清楚。
   目的：本研究旨在评估：在一个大的真实世界中，持续性哮喘成人患者基线体重指数（BMI）和后续的哮喘控制措施间的关系。
   方法：在南加州凯萨医疗机构（KPSC），一个大型管理式医疗机构，我们2006年招募了满足以下条件的成人持续性哮喘患者： 2007-2008年持续进行健康计划登记，且在2006/2007年测量过BMI。根据每位患者在2006年或2007年最后一次测量的BMI值，将其分组：正常组 (<25 kg/m2)、超重组 (25-29.9 kg/m2)或肥胖组 (≥30 kg/m2)。2008年的哮喘控制结局包括：因哮喘住院或急诊就诊（EDHO）、与哮喘发作相关的口服类固醇激素的使用（OCS）和短效β-受体激动剂使用≥7罐（SABA7）。控制潜在混杂因素后，采用多变量分析评估BMI分组与哮喘控制结局的相关性。
   结果：该研究共纳入10233例成年患者。在调整了混杂因素（潜在的人口统计学特征、伴发病和优先使用）后，研究发现：超重和肥胖个体EDHO的相对风险(RR)增加(RR 1.40, 95% 可信区间 1.10-1.78)。在校正分析中，只有肥胖与高SABA7相对风险相关(RR 1.27, 95% 可信区间 1.15-1.40)。
   结论：增加的BMI，特别是肥胖，与后续的哮喘控制不良特别是风险方面（急性发作）显著相关。这些发现进一步支持：减重在超重和肥胖成年哮喘患者中具有非常重要的意义。
 

（杨冬 审校）
JAllergyClinImmunolPract. 2015May8.pii:S2213-2198(15)00137-3.doi:10.1016/j.jaip.2015.03.017. [Epub ahead of print]


 

Prospective Study on the Relationship of Obesity to Asthma Impairment and Risk.
 

Schatz M1, Zeiger RS2, Yang SJ3, Chen W3, Sajjan S4, Allen-Ramey F4, Camargo CA Jr5.
 

Abstract
BACKGROUND:Although studies consistently show an association between obesity and increased asthma incidence, the role of obesity in asthma control is less clear.
OBJECTIVE:The objective of this study was to evaluate the association between baseline body mass index (BMI) and measures of subsequent asthma control in a large real-world cohort of adults with persistent asthma.
METHODS:In Kaiser Permanente Southern California (KPSC), a large managed care organization, we identified adults with persistent asthma in 2006, continuous health plan enrollment in 2007 and 2008, and a BMI measurement in 2006 or 2007. Each patient's last BMI measure in 2006 or 2007 was categorized into a BMI group: normal (<25 kg/m2), overweight (25-29.9 kg/m2), or obese (≥30 kg/m2). Asthma control outcomes in 2008 included asthma hospitalizations or emergency department visits (EDHO), oral corticosteroid dispensings linked to an asthma encounter (OCS), and dispensing of ≥7 short-acting beta-agonist canisters (SABA7). Multivariable analyses were conducted to assess the relationships of BMI categories with the risk of the asthma control outcomes after controlling for potential confounders.
RESULTS:In the 10,233 eligible adults-after adjusting for potential demographic, comorbidity, and prior utilization confounders-we found an increased relative risk (RR) of EDHO in overweight and obese (RR 1.40, 95% CI 1.10-1.78) individuals. Only obesity was associated in adjusted analyses with a significant increased relative risk of SABA7 (RR 1.27, 95% CI 1.15-1.40).
CONCLUSIONS:Elevated BMI, particularly obesity, is associated with subsequent poor asthma control, especially in the risk domain (exacerbations). These findings further support the importance of facilitating weight loss in overweight and obese adults with asthma.
 

JAllergyClinImmunolPract. 2015May8.pii:S2213-2198(15)00137-3.doi:10.1016/j.jaip.2015.03.017. [Epub ahead of print]