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Original Research |

Obesity is Associated with Increased Morbidity in Moderate to Severe COPD

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

Notation of prior abstract publication/presentation: These data have been previously presented at the 2015 American Thoracic Society International Conference in Denver, CO.

Competing Interests and Research Funding Source: This work was supported by NIH grants: Genetic Epidemiology of COPD [R01 HL089856, PI: Silverman and R01 HL089897, PI: Crapo]. Dr. Lambert is supported by NIH grant KL2 TR001077 03. Dr. Putcha is supported by NIH grant K23 HL123594 . Dr. Kim is supported by NIH grant K23 HL094696. McDonald is supported by NIH NHLBI 1K99HL121087-01A1. Dr. Brigham is supported by 4KL2TR001077-04. Drs. Hansel and McCormack have received funding from EPA grant number RD-83615001 and NIH grant numbers P50MD010431 and R01ES022607. Dr. Hansel is additionally supported by NIH grant R01ES023500. Authors do not report any conflicts of interest.

1Department of Medicine; Division of Pulmonary and Critical Care; Johns Hopkins University, Baltimore, MD, USA

2Department of Medicine; Division of Pulmonary and Critical Care; Baylor College of Medicine, Houston, TX, USA

3Department of Medicine; Division of Pulmonary and Critical Care; Temple University, Philadelphia, PA, USA

4Department of Epidemiology; Colorado School of Public Health, University of Colorado, Aurora, CO, USA

5Channing Division of Network Medicine; Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

Corresponding author. 1830 East Monument St 5th Floor, Division of Pulmonary and Critical Care Baltimore, MD 21205.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.08.1432
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Abstract

Background  Obesity is prevalent in the United States; however the impact of obesity upon COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD.

Methods  We examined 3631 participants from the multicenter prospective cohort study COPDGene who had spirometry confirmed COPD, a post-bronchodilator FEV1 <80% predicted and a body mass index (BMI) ≥18.5kg/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 18.5-29.9kg/m2).

Results  Overall, 35% of participants were obese, with 21% class I (BMI 30-34.9kg/m2), 9% class II (BMI 35-39.9kg/m2) and 5% class III (BMI ≥ 40kg/m2). The number of comorbidities increased with increasing obesity class (p<0.001). 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 v2, respectively), reduced 6 minute walk distance (6MWD), increased dyspnea (modified Medical Research Council score of ≥2) and greater odds of a 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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