哮喘联盟

   摘要
   背景：有研究表明，肥胖与哮喘的发生、较严重的临床表现以及较差的病情控制相关。但是，肥胖与急性哮喘发病率的相关性仍不明确。
   目的：本项目旨在研究因哮喘恶化而就诊急诊科的肥胖成年哮喘患者的住院治疗频率是否较体重正常的哮喘患者更高。
   方法：我们对美国23个州里48个急诊科的哮喘病例进行多中心回顾性研究。纳入的病例为2011－2012年间因哮喘恶化而就诊急诊科的18～54岁哮喘患者。主要结局指标为住院治疗。
   研究指标及主要结果：本项目总共研究了1227名患者。在这些病例中，有323名患者（27%）的体重超标（体重指数：25-29.9 kg/m2），607名可诊断为肥胖症（体重指数大于30 kg/m2）。在607名肥胖症患者中，又有364名患者（60%）为重度肥胖（体重指数≥35 kg/m2）。关于哮喘慢性严重程度及控制情况的几个指标以及急性疾病严重程度在不同体重指数群体间无显著差异。但是，与正常体重群体相比，体重超标的哮喘患者（11% vs. 18%；优势比，1.68； 95%可信区间，1.05-2.68； P=0.03）及肥胖症患者（11% vs. 23%；优势比，2.30； 95%CI， 1.53-3.49；P<0.001）的住院频率显著增高。采用多重替代法进行分析校正后，体重超标患者与正常体重患者的住院率无显著差异（优势比，1.56； 95%CI，0.90-2.71; P=0.11），但肥胖症患者的住院率仍显著高于正常体重患者（优势比，1.69；95%CI，1.02-2.81； P=0.04）。此外，重度肥胖症患者的住院率更高（优势比，1.95； 95%CI，1.13-3.34；P=0.02）。
   结论：此次对于因哮喘恶化而就诊急诊科的哮喘患者的多中心回顾性研究结果表明，与正常体重患者相比，肥胖症哮喘患者的住院率显著增高。
 

（苏楠 审校）
Ann Am Thorac Soc. 2014 Oct 14. [Epub ahead of print]

 

Body Mass Index and Risk of Hospitalization Among Adults Presenting with Asthma Exacerbation to the Emergency Department.
 

Hasegawa K1, Tsugawa Y, Lopez BL, Smithline HA, Sullivan AF, Camargo CA Jr.
 

Abstract
RATIONALE: Studies have linked obesity to incident asthma and worse chronic severity/control. However, the relationship between obesity and acute asthma morbidity remains unclear.
OBJECTIVES: To determine whether obese adults presenting to the emergency department (ED) with asthma exacerbation are at higher risk of hospitalization, compared to normal-weight adults.
METHODS: Multicenter chart review study of 48 EDs across 23 US states. We identified ED patients aged 18 to 54 years with asthma exacerbation during 2011-2012. Primary outcome was hospitalization. Measurements and Main Results: The analytic cohort comprised 1227 patients. Of these, 323 patients (27%) were overweight (BMI 25-29.9 kg/m2), and 607 (50%) were obese (BMI ≥30 kg/m2). Among the 607 obese patients, 364 patients (60%) were severely obese (BMI ≥35 kg/m2). Several markers of chronic severity/control of asthma and acute severity did not differ across BMI groups. By contrast, compared to normal-weight patients, the risk of hospitalization was higher in patients who were overweight (11% vs. 18%; OR 1.68; 95%CI, 1.05-2.68; P=0.03) or obese (11% vs. 23%; OR, 2.30; 95%CI, 1.53-3.49; P<0.001). In the adjusted analysis with multiple imputation, the association lost statistical significance in overweight patients (OR, 1.56; 95%CI, 0.90-2.71; P=0.11) but persisted in obese patients (OR, 1.69; 95%CI, 1.02-2.81; P=0.04). The latter finding was driven by an even higher risk of hospitalization in severely obese patients (OR, 1.95; 95%CI, 1.13-3.34; P=0.02).
CONCLUSIONS: In this multicenter study of ED patients with asthma exacerbation, we found that obese adults were at a higher risk of hospitalization compared to normal-weight adults.
 

Ann Am Thorac Soc. 2014 Oct 14. [Epub ahead of print]