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a Institute of
Respiratory Medicine, University of Sydney, Sydney, NSW 2006, Australia, b Clinical Epidemiology Unit, University of
Sydney, Department of Paediatrics and Child Health, New Children's
Hospital, Westmead, NSW 2145, Australia, c Department of Respiratory Medicine, Austin and
Repatriation Medical Centre, Heidelberg, Victoria 3084, Australia
Correspondence to: Dr L Schachter, Department of Respiratory Medicine, Austin and Repatriation Medical Centre, Studley Rd, Heidelberg, Victoria 3084, Australia lindams{at}bigpond.com
Received 10 March 2000; Returned to authors 15 May 2000; Revised version received 8 August 2000; Accepted for publication 8 September 2000
BACKGROUND
A study was
undertaken to assess whether the recent increases in prevalence of both
asthma and obesity are linked and to determine if obesity is a risk
factor for diagnosed asthma, symptoms, use of asthma medication, or
airway hyperresponsiveness.
METHODSData from 1971 white adults aged 17-73 years from three large epidemiological studies
performed in NSW were pooled. Doctor diagnosis of asthma ever, history
of wheeze, and medication use in the previous 12 months were obtained
by questionnaire. Body mass index (BMI) in kg/m2 was used
as a measure of obesity. Airway hyperresponsiveness (AHR) was defined
as dose of <3.9 µmol histamine required to provoke a fall in forced
expiratory volume in one second (FEV1) of 20% or more
(PD20FEV1). Adjusted odds ratios (OR) were
obtained by logistic regression.
RESULTSAfter
adjusting for atopy, age, sex, smoking history, and family history,
severe obesity was a significant risk factor for recent asthma (OR
2.04, p=0.048), wheeze in the previous 12 months (OR 2.6, p=0.001), and
medication use in the previous 12 months (OR 2.83, p=0.005), but not
for AHR (OR 0.87, p=0.78). FEV1 and forced vital capacity
(FVC) were significantly reduced in the group with severe obesity, but
FEV1/FVC ratio, peak expiratory flow (PEF), and mid forced
expiratory flow (FEF25-75) were not different from the
group with normal BMI. The underweight group (BMI
<18.5 kg/m2) had increased symptoms of shortness of
breath, increased airway responsiveness, and reduced FEV1,
FVC, PEF, and FEF25-75 with similar use of asthma
medication as subjects in the normal weight range.
CONCLUSIONSAlthough
subjects with severe obesity reported more wheeze and shortness of
breath which may suggest a diagnosis of asthma, their levels of atopy,
airway hyperresponsiveness, and airway obstruction did not support the
suggestion of a higher prevalence of asthma in this group. The
underweight group appears to have more significant respiratory problems
with a higher prevalence of symptoms, reduced lung function, and
increased airway responsiveness without an increase in medication
usage. This group needs further investigation.
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