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Original Research: ASTHMA |

Body Mass Index and Response to Emergency Department Treatment In Adults With Severe Asthma Exacerbations*: A Prospective Cohort Study

Gustavo J. Rodrigo, MD; Vicente Plaza, MD
Author and Funding Information

*From the Departamento de Emergencia (Dr. Rodrigo), Hospital Central de las FF.AA, Montevideo, Uruguay; and Departament de Pneumologia (Dr. Plaza), Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.

Correspondence to: Gustavo J. Rodrigo, MD, Departamento de Emergencia, Hospital Central de las FF.AA, Av. 8 de Octubre 3020, Montevideo 11600, Uruguay; e-mail: gurodrig@adinet.com.uy



Chest. 2007;132(5):1513-1519. doi:10.1378/chest.07-0936
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Background: In acute asthma (AA), overweight/obesity (body mass index [BMI] ≥ 25 kg/m2) have been related to poorer outcomes and higher risk of complications.

Methods: We designed a prospective cohort study to determine if overweight/obese adults with severe episodes of AA require longer duration of emergency department (ED) treatment and have higher hospitalization rates compared with underweight/normal asthmatics (BMI < 25 kg/m2). All patients received inhaled albuterol (maximum 6 h). Patients were discharged or admitted according to standard accepted criteria. The weight and height of each patient were measured during the ED stay.

Results: Four hundred twenty-six patients (mean, 33.4 ± 11.5 years [± SD]; 63% women) with severe exacerbations (FEV1, 28.2 ± 11.9% of predicted) were enrolled. One hundred sixty-three patients (38.3%) were classified as overweight/obese. Patients with BMI ≥ 25 kg/m2 showed significant increases in length of ED stay (2.3 h vs 1.9 h, p = 0.01) and rate of hospitalization (13.7% vs 6.8%, p = 0.02), despite adjustments for other confounding variables. They also presented a higher rate of use of inhaled steroids and theophylline within the past 7 days. At the end of treatment, overweight/obese patients displayed more wheezing. Multivariate analysis demonstrated that BMI ≥ 25 kg/m2 resulted unrelated to final change in peak expiratory flow from baseline. By contrast, BMI ≥ 25 kg/m2 was related with duration of ED treatment (p = 0.002).

Conclusions: Overweight/obese patients were admitted to the hospital more frequently than underweight/normal patients. This may reflect a difference in the perception of dyspnea, or it may reflect an underlying difference in asthma severity between the two groups.

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