Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults

Authors

  • S. Fitzpatrick,

    1. Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
    2. Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY, USA
    3. Department of Dermatology, St. Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, USA
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  • R. Joks,

    1. Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
    2. Department of Allergy and Immunology, State University of New York Downstate Medical Center, Brooklyn, NY, USA
    3. Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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  • J. I. Silverberg

    Corresponding author
    1. Center for Allergy and Asthma Research, State University of New York Downstate Medical Center, Brooklyn, NY, USA
    2. Department of Dermatology, St. Luke's-Roosevelt Hospital and Beth Israel Medical Centers, New York, NY, USA
    • Department of Medicine, State University of New York Downstate Medical Center, Brooklyn, NY, USA
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Correspondence:

Jonathan I. Silverberg, Suite 11B, Department of Dermatology, St. Luke's-Roosevelt Hospital Center, 1090 Amsterdam Ave, New York, NY 10025, USA.

E-mail: jonathanisilverberg@gmail.com

Summary

Background

Obesity is associated with increased asthma and atopy.

Objective

To determine whether or not obesity in inner-city adults is associated with increased asthma prevalence, severity and exacerbations and IgE responses.

Methods

This retrospective study involved 246 adults with asthma and other atopic disorders who were seen at an asthma clinic in New York City between 1997 and 2010. Height, weight, asthma diagnosis and symptoms, peak flow (PF), spirometry, serum IgE levels and white blood cell differentials were recorded.

Results

Asthmatic patients had higher body mass index than non-asthmatics (median, interquartile range: 30.5, 10.2 vs. 27.8, 8.8; Mann–Whitney U-test, = 0.0006). Class I and II/III obesity were associated with increased asthma (I: OR: 2.35, 95% CI: 1.04–5.34, = 0.04; II/III: OR: 3.25, 95% CI: 1.36–7.74, = 0.008). Class I and II/III obesity were associated with worsened asthma severity (ordinal logistic regression; I: OR: 4.23, 95% CI: 1.61–11.06, = 0.003; II/III: OR: 2.76, 95% CI: 1.08–7.09, = 0.03). Class II/III obesity was associated with increased asthma exacerbations requiring oral corticosteroids (repeated measures logistic regression, OR: 1.13, 95% CI: 1.03–1.25; = 0.01) and increased requirement of inhaled corticosteroid for long-term asthma management (OR: 1.45, 95% CI: 1.29–1.62; < 0.0001). In asthmatics, class II/III obesity was associated with decreased PF (general linear model, least squares mean ± SEM: 333.8 ± 37.4 vs. 396.2 ± 32.1 L/min; = 0.007), forced expiratory volume in 1 s (75.2 ± 4.6 vs. 88.4 ± 5.6%; = 0.03) and forced vital capacity (83.2 ± 4.7 vs. 109.2 ± 6.0%; = 0.0002) and increased serum IgE (480.2 ± 88.3 vs. 269.0 ± 66.6 IU/mL; = 0.04) and neutrophils (66.6 ± 3.7 vs. 60.1 ± 3.8%; = 0.02). Class I obesity was also associated with increased serum IgE (458.7 ± 68.9, P = 0.03).

Conclusion and clinical relevance

Obesity in inner-city adults may be both a risk and exacerbating factor for atopic asthma.

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