Risk for exacerbations, hospitalization higher in patients with adult-onset asthma, obesity

Patients with adult-onset asthma and long-term obesity had more asthma exacerbations and respiratory-related hospitalizations compared with patients with normal weight at diagnosis over 12 years of follow-up, researchers reported.

“[Obesity] has been proposed to associate with poor outcomes of asthma, such as poor disease control, increased use of oral steroids, urgent visits to health care and lower lung function, but the results are not consistent,” Pinja Ilmarinen, PhD, researcher in the department of respiratory medicine at Seinäjoki Central Hospital, Finland, and colleagues wrote in the European Respiratory Journal.

For a new study, researchers categorized 203 patients diagnosed with adult-onset asthma according to BMI: less than 25 kg/m² (n = 65; 61.5% women), 25 kg/m² to 29.9 kg/m² (n = 89; 56.2% women) and 30 kg/m² or higher (n = 49; 57.1% women). Patients were followed for 12 years, and researchers assessed self-reported and dispensed oral corticosteroids and analyzed hospital admission data.

At follow-up, 86% of patients with a BMI of at least 30 kg/m² at diagnosis remained obese.

Patients with obesity at the time of their asthma diagnosis reported more frequent oral corticosteroid use (46.9% vs. 23.1%; P = .028) during follow-up compared with patients with normal weight. These patients were also dispensed oral corticosteroids more often (81.6% vs. 56.9%; P = .014) and at higher doses (median, 1,350 mg vs. 600 mg prednisolone; P = .01) compared with patients with normal weight.

In addition, patients with obesity at asthma diagnosis experienced one or more respiratory-related hospitalizations compared with patients with normal weight (38.8% vs. 16.9%; P = .033).

When researchers performed a multivariate logistic regression analysis, dispensing one or more oral corticosteroid, female sex, diagnostic obesity and blood eosinophil level before beginning treatment were found as predictors of oral corticosteroid use..

There was no difference in weight gain between patients in the three BMI categories at 12 years.

“As current treatments are less effective in obese patients, and as weight loss has many beneficial effects, weight loss should be prioritized in the management of asthma in obese patients,” the researchers wrote.