Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD

Allison A. Lambert, Nirupama Putcha, M. Bradley Drummond, Aladin M. Boriek, Nicola A. Hanania, Victor Kim, Gregory L. Kinney, Merry Lynn N McDonald, Emily Brigham, Robert A Wise, Meredith McCormack, Nadia Hansel

Research output: Contribution to journalArticle

Abstract

Background Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. Methods We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2). Results Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations. Conclusions Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.

Original languageEnglish (US)
Pages (from-to)68-77
Number of pages10
JournalChest
Volume151
Issue number1
DOIs
StatePublished - Jan 1 2017

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Chronic Obstructive Pulmonary Disease
Obesity
Morbidity
Dyspnea
Comorbidity
Quality of Life
Molecular Epidemiology
Spirometry
Biomedical Research
Linear Models
Cohort Studies
Logistic Models
Regression Analysis
Prospective Studies

Keywords

  • COPD
  • dose response
  • exacerbation
  • morbidity
  • obesity

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD. / Lambert, Allison A.; Putcha, Nirupama; Drummond, M. Bradley; Boriek, Aladin M.; Hanania, Nicola A.; Kim, Victor; Kinney, Gregory L.; McDonald, Merry Lynn N; Brigham, Emily; Wise, Robert A; McCormack, Meredith; Hansel, Nadia.

In: Chest, Vol. 151, No. 1, 01.01.2017, p. 68-77.

Research output: Contribution to journalArticle

Lambert, AA, Putcha, N, Drummond, MB, Boriek, AM, Hanania, NA, Kim, V, Kinney, GL, McDonald, MLN, Brigham, E, Wise, RA, McCormack, M & Hansel, N 2017, 'Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD', Chest, vol. 151, no. 1, pp. 68-77. https://doi.org/10.1016/j.chest.2016.08.1432
Lambert AA, Putcha N, Drummond MB, Boriek AM, Hanania NA, Kim V et al. Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD. Chest. 2017 Jan 1;151(1):68-77. https://doi.org/10.1016/j.chest.2016.08.1432
Lambert, Allison A. ; Putcha, Nirupama ; Drummond, M. Bradley ; Boriek, Aladin M. ; Hanania, Nicola A. ; Kim, Victor ; Kinney, Gregory L. ; McDonald, Merry Lynn N ; Brigham, Emily ; Wise, Robert A ; McCormack, Meredith ; Hansel, Nadia. / Obesity Is Associated With Increased Morbidity in Moderate to Severe COPD. In: Chest. 2017 ; Vol. 151, No. 1. pp. 68-77.
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abstract = "Background Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. Methods We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80{\%} predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2). Results Overall, 35{\%} of participants were obese, with 21{\%} class I (BMI range, 30-34.9 kg/m2), 9{\%} class II (BMI range, 35-39.9 kg/m2), and 5{\%} class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations. Conclusions Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.",
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AU - Lambert, Allison A.

AU - Putcha, Nirupama

AU - Drummond, M. Bradley

AU - Boriek, Aladin M.

AU - Hanania, Nicola A.

AU - Kim, Victor

AU - Kinney, Gregory L.

AU - McDonald, Merry Lynn N

AU - Brigham, Emily

AU - Wise, Robert A

AU - McCormack, Meredith

AU - Hansel, Nadia

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N2 - Background Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. Methods We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2). Results Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations. Conclusions Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.

AB - Background Obesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD. Methods We examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2). Results Overall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations. Conclusions Obesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.

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KW - morbidity

KW - obesity

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