Obesity heightens risk for poor outcomes, adverse events among patients with asthma

SAN ANTONIO — Patients with asthma and obesity faced elevated risks for poor outcomes related to health, money and hospitalization, according to a study presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting.

“Patients who are obese with asthma had a higher risk of near-fatal events such as tracheostomy, respiratory arrest and/or cardiac arrest,” Karl Mueller, MD, PhD, internal medicine resident at Mayo Clinic in Jacksonville, Fla., told Healio. “These data show that patients who have asthma and are obese are at higher risk of near-fatal events than those who have asthma and are not obese.”

In a retrospective review, Mueller and colleagues used 2005 to 2014 data from the National Inpatient Sample to assess 677,591 cases of asthma exacerbations (mean age, 47.8 years; standard deviation, 23.8; 66% female; 52% white; 86% non-Hispanic) in patients aged 5 years or older to determine if obesity (BMI 30 kg/m²) is linked to negative asthma outcomes.

Of all exacerbations, 125,095 (18%) occurred among patients with obesity. Researchers also observed 2,538 (0.37%) all-cause fatal events and 936 (0.14%) near-fatal asthma events in the total cohort.

In terms of near-fatal asthma events, 0.2% of patients with asthma and obesity experienced this type of event, compared with 0.1% of patients with asthma and normal weight (P < .02).

“If confirmed with further studies, this could potentially make primary care physicians spend extra time focusing on weight loss in patients who have asthma and obesity as a comorbidity, as they do for patients who are obese with diabetes or osteoarthritis,” Mueller told Healio. “In addition, this could be a group that expresses different immunometabolism than patients who have asthma and are not obese, and thus may have new biological targets for therapeutics in the future.”

Additionally, researchers found that patients with asthma and obesity had longer mean hospital stays (4.2 days vs. 3.5 days) and higher mean total direct cost ($24,550 vs. $18,973; P < .0001 for both) than patients with asthma and without obesity.

“Future studies will likely look into the mechanisms of this increase in near-fatal events,” Mueller told Healio. “For instance, does the increase in near-fatal events in patients who are obese stem from a worsening or unique presentation of asthma? Or does obesity increase the risk for other pulmonary pathologies such as obesity hypoventilation syndrome, that as a comorbidity of asthma creates higher risk?”

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Karl Mueller, MD, PhD, can be reached at mueller.karl2@mayo.edu.