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Original Research: COPD |

Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD

Allison A. Lambert, MD; Nirupama Putcha, MD; M. Bradley Drummond, MD; Aladin M. Boriek, PhD; Nicola A. Hanania, MD; Victor Kim, MD; Gregory L. Kinney, MPH, PhD; Merry-Lynn N. McDonald, PhD; Emily P. Brigham, MD; Robert A. Wise, MD; Meredith C. McCormack, MD; Nadia N. Hansel, MD, MPH
Author and Funding Information

FUNDING/SUPPORT: This study was funded by the National Institutes of Health Genetic Epidemiology of COPD [Grant R01 HL089856] to Dr Silverman (PI) and [Grant R01 HL089897] to Dr Crapo (PI); the National Institutes of Health [Grant KL2 TR001077] to A. A. L., [Grant K23 HL123594] to N. P., [Grant K23 HL094696] to V. K., [Grants P50MD010431 and R01ES022607] to N. N. H. and M. C. M., and [Grant R01ES023500] to N. N. H.; the National Institutes of Health, National Heart, Lung, and Blood Institute [Grant 1K99HL121087-01A1] to M.-L. N. M.; the National Institutes of Health, National Center for Advancing Translational Sciences [Grant 4KL2TR001077-04] to E. P. B.; and the Environmental Protection Agency [Grant RD-83615001] to N. N. H. and M. C. M.

aDepartment of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD

bDepartment of Medicine, Division of Pulmonary and Critical Care, Baylor College of Medicine, Houston, TX

cDepartment of Medicine, Division of Pulmonary and Critical Care, Temple University, Philadelphia, PA

dDepartment of Epidemiology, Colorado School of Public Health, University of Colorado, Aurora, CO

eChanning Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA

CORRESPONDENCE TO: Allison A. Lambert, MD, 1830 E Monument St, 5th Floor, Division of Pulmonary and Critical Care, Baltimore, MD 21205


Copyright 2016, American College of Chest Physicians. All Rights Reserved.


Chest. 2017;151(1):68-77. doi:10.1016/j.chest.2016.08.1432
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Background  Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD.

Methods  We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2).

Results  Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George’s Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations.

Conclusions  Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.

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