Body mass index and response to emergency department treatment among adults with severe asthma exacerbations: a prospective cohort study.
Chest. 2007 Sep 21
Rodrigo GJ, Plaza V.
Departamento de Emergencia, Hospital Central de las FF.AA. Av. 8 de Octubre 3020, Montevideo 11600, Uruguay. Phone: (5982) 487-0165, Fax (5982) 487-2506.
In acute asthma (AA), overweight/obesity (BMI >/= 25 kg/m(2)) have been related to poorer outcomes and higher risk of complications.
We designed a prospective cohort study to determine if overweight/obese adults with severe episodes of AA require longer duration of ED treatment and have higher hospitalization rates compared with underweight/normal asthmatics (BMI<25 kg/m(2)). 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.
Four hundred twenty-six patients (33.4 +/- 11.5 y, 63% female) with severe exacerbations (FEV(1) = 28.2 +/- 11.9%) were enrolled. One hundred sixty three patients (38.3%) were classified as overweight/obese. BMI >/= 25 patients showed significant increases in the length of ED stay (2.3 h vs. 1.9 h, p = 0.01), and in the 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 seven days. At the end of treatment overweight/obese patients displayed more wheezing. Multivariate analysis demonstrated that a BMI >/= 25 resulted unrelated to final change PEF from baseline. By contrast, BMI >/= 25 was related with duration of ED treatment (p = 0.002).
Overweight/obese patients were admitted more frequently than underweight/normal patients. This may reflect a difference in the perception of dyspnea or may reflect and underlying difference in asthma severity between the two groups.