Characterization of Self-reported Asthma in Morbidly Obese WomenObservational studies have shown obesity to be associated with increased risk of asthma and changes in lung volumes that may mimic asthma. The objective of this study was to examine differences in pulmonary function profile, respiratory symptoms, and quality of life in morbidly obese women based on self-reported asthma. Cross-sectional analysis was performed on adults recruited from the Johns Hopkins Bariatric Center. The following measures were obtained: demographics, anthropometrics, respiratory symptoms questionnaires, general health questionnaire, pulmonary function test, and methacholine challenge test. The study population consisted of 42 women with mean age of 42 years; the majority was African American. Based on the St. George’s respiratory symptoms questionnaires, asthmatics had increased report of respiratory symptoms in the following domains: Symptoms, Impact and Total. Compared to the normalize data, both groups had lower quality of life based on the Physical Health score and Mental Health score on the SF-36. Asthmatics had lower Mental Health scores than non asthmatics. There was a trend for those with self-reported asthma to have significantly lower FEV1/FVC ratio. In conclusion, obese women had a significant decrease in overall quality of life and increased report of respiratory symptoms. Asthmatic obese women had significantly more respiratory complaints and lower quality of life.

• Obesity is associated with changes in lung volumes which may mimic asthma.

• Observational studies have identified obesity to be associated with increased risk of asthma.

• To date it is unclear whether the asthma phenotype is different in obese patients as a result of the effects of weight on the respiratory system.

Abstract

Background

Sample Population: Participants were recruited from the Johns Hopkins Bariatric Center, while undergoing evaluation for bariatric surgery. The following eligibility criteria were used:

• Age 18 years or older

• Asthma diagnosis was based on self-reported and documented use of asthma medication.

Data Collection: The following measures were obtained:

• Demographics (age and ethnicity)

• Anthropometrics (height, weight, neck, chest, waist to hip circumference)

• Full Pulmonary Function Test with bronchodilator challenge

• Respiratory symptom questionnaire (St. George’s and Asthma Control Test in those with asthma)

• General health questionnaire (SF-36)

• Airway hyper-responsiveness was assessed in a subset of participants.

Statistical Analysis: T-test and chi-square were used to assess between group differences for continuous and categorical values.

Alton R Johnson Jr.1, Mercedes Proctor2, Andrew Bilderback2, Cynthia S Rand2, and Emmanuelle M Clerisme-Beaty2

1Barry University, Miami Shores FL, 2 Johns Hopkins University Medicine, Baltimore MDEmail: Alton.Johnson@mymail.barry.edu

Program No. 609.14

To examine differences in pulmonary function profile, respiratory symptoms, and quality of life in morbidly obese women based on self-reported asthma.

General Health Survey (SF-36)• Compared to normalize data both groups had lower quality of life• Asthmatics had a trend lower mental health scores with no significant difference in physical health domain

Objective

Participant Characteristics • 53 participants were recruited to participate in the study.

– 11 were excluded based on gender, leaving 42 women in the final analysis.– There was no statistically significant difference in demographics by asthma status.

St. George’s Respiratory Questionnaire• There was significant impairment in quality of life related to respiratory symptoms in both groups.• However, asthmatics were more affected by respiratory symptoms in comparison to non-asthmatics.

Airway Hyper-responsiveness• 24 participants (6 asthmatics, 18 non-asthmatics)

– 60% asthmatics had positive AHR – 40% non-asthmatics had positive AHR

Pulmonary Function Profile• Obesity was associated with significant reduction in FRC (66.9%).• There was a trend for those with self-reported asthma to have significantly lower FEV1/FVC ratio (Fig 3.), with no significant response to albuterol.• There was no significant difference in lung volume by asthma status.

• Significant decrease in overall quality of life and increase report of respiratory symptoms in both groups

• Compared to non-asthmatic women, those with asthma had significantly more respiratory complaints and lower quality of life.

• There was a trend for lower FEV1/FVC in morbidly obese women with and without asthma.

• There was higher than expected prevalence of AHR in obese women without clinical diagnosis of asthma.

• It is unclear whether these findings apply to men or patients with less severe obesity.

• Since methacholine challenge testing was optional, this may have introduced selection bias and impacted our results.

• The observed differences in symptoms by asthma status in the absence of significant differences in pulmonary profile suggest that symptoms rather than objective differences in respiratory function may guide the diagnosis of asthma in this population.

• NIH/NHLBI grant R25 HL084762, Johns Hopkins University• NIH grant K12RR01767, Johns Hopkins University• NIH-NIGMS RISE Grant, R25 GM059244-09, Barry University

Results

Materials and Methods

Implications

Funding

Results (Cont’d)Results (Cont’d)

Limitations

Conclusions