Anxiety, BMI affect asthma control regardless of physical activity

Anxiety and BMI can affect asthma control regardless of physical activity levels, according to a study published in The Journal of Allergy and Clinical Immunology: In Practice.

Specifically, asthma and BMI can be considered “treatable traits” of patients with asthma that can be addressed via personalized medicine to improve the quality of life and asthma control in this population.

“Treatable traits are disease characteristics that are clinically relevant, identifiable measurable and can be treated. In asthma, these traits could influence asthma control, both acutely (ie, exacerbations) and in stable disease” Leyre Baptista-Serna, MD, of the IIS-Fundación Jiménez Díaz in Madrid, Spain, and colleagues wrote, adding that treatable traits in asthma have been categorized into three domains: pulmonary, extra-pulmonary and lifestyle risk factors.

In order to assess the association between treatable traits and asthma outcomes, Baptista-Serna and colleagues analyzed data of 434 patients with asthma who they categorized as with or without obesity (BMI < 30 mg/kg² vs. 30 mg/kg²), with or without anxiety according to the Hospital Anxiety Depression Scale (HADS; normal rating, < 8; anxiety, 8) and active or inactive ( 2 hours vs. < 2 hours of weekly exercise).

Based on these categories, researchers divided patients into four groups: Group 1 included active patients without anxiety and without obesity (n = 80; 67.5% female; mean age, 47.7 years); Group 2 included active patients with anxiety and/or obesity (n = 61; 73.7% female; mean age, 51.9 years); Group 3 included inactive patients without anxiety or obesity (n = 119; 59.6% female; mean age, 44.8 years); and Group 4 included inactive patients with anxiety and/or obesity (n = 174; 66% female; mean age, 47.1 years).

Researchers compared asthma outcomes among these groups of patients using the Asthma Control Test (ACT) and the mini Asthma Quality of Life Questionnaire, showing significant differences between those with or without treatable traits (P < .0001).

The researchers noted that patients who were physically inactive but did not have anxiety or obesity had lower rates of asthma exacerbation. However, this might have been due to a smaller patient population or the fact that leading a physically inactive lifestyle may lead to fewer asthma exacerbations.

The next evaluation included BMI, comorbidities, any psychiatric illness, thyroid disease, ACT, hours of exercise per week, depression and anxiety, along with active or inactive lifestyle.

Results supported the findings that the treatable traits of asthma and BMI could affect both asthma control and quality of life.

“Interestingly, based on these results, exercise did not seem to play a key role in asthma control, even though studies have demonstrated that exercise leads to weight control and improvement of anxiety,” the researchers wrote.

Baptista-Serna and colleagues noted their findings may be limited because they did not objectively measure physical activity, nor did they take into account the influence of asthma exacerbations, lung function and severity in the cluster analysis.

“Inclusion of treatable traits such as obesity and anxiety would be easily accomplished in daily clinical practice,” they concluded. “Doing so would allow the use of personalized medicine with simple and inexpensive methods (ie, inquiring patients as to hours of physical activity, anthropometric measures, and a questionnaire such as HADS) to predict which subjects will have a poor asthma control and worse perception of their quality of life.”