作者：Laurie Barclay, MD
出處：WebMD醫學新聞
September 4, 2008 — 根據9月號過敏與臨床免疫學期刊中的橫斷面研究報告，有氣喘的肥胖病患，其住院風險可能是有氣喘但非肥胖者的5倍。
主要作者、奧勒岡波特蘭Kaiser Permanente健康研究中心的David M. Mosen博士在新聞稿中表示，重大發現是，即使在校正風險因素之後，肥胖病患因為氣喘而住院的風險將近5倍；美國有近30%人口屬於肥胖，本研究點出另一個肥胖的長期風險，其他風險包括心臟病、糖尿病、中風和失智。
研究目標是評估肥胖(身體質量指數[BMI] > 30 kg/m2)、生活品質、氣喘控制、氣喘相關住院等的關聯。
隨機從一個大型整合健康照護機構選取1,113名會員作為樣本，這些人至少35歲，且有因為氣喘而接受健康照護，他們在家裡完成問卷；研究終點包括迷你氣喘生活品質問卷、氣喘治療評估問卷以及自述氣喘住院。
研究者也分析其他影響氣喘結果的變項，包括人口統計學因素、抽菸狀態、過去一個月內使用口服或者吸入式皮質類固醇、以及有胃食道逆流疾病(GERD)，同時，使用多重邏輯回歸模式確認BMI與結果的關聯。
結果顯示，即使在校正人口統計學因素、抽菸狀態、口服皮質類固醇、GERD與使用吸入式皮質類固醇(ICS)之後，相較於正常BMI (<25 kg/m2)者，肥胖成人比較可能有不佳的氣喘特定生活品質(勝算比[OR], 2.8; 95% 信心區間[CI], 1.6 – 4.9)、不佳的氣喘控制(OR, 2.7; 95% CI, 1.7 – 4.3)以及有氣喘相關住院史(OR, 4.6; 95% CI, 1.4 – 14.4)。
根據這些研究發現，研究作者結論表示，即使在校正其他病患特徵和治療之後，肥胖與不佳的氣喘結果有關— 特別是增加氣喘住院風險。
本研究的限制包括屬於橫斷面設計、自述身高與體重、缺乏肺量計測量、未回覆者之闕漏值、可能缺乏其他健康照護體系之氣喘肥胖成年人的一般資料；研究作者建議發展實施後續研究，評估促進肥胖氣喘族群的減重方式，之後確認這些介入方式對於氣喘特定結果的影響。
研究共同作者、加州聖地牙哥Kaiser Permanente醫學中心過敏科主任Michael Schatz醫師表示，本研究提供給醫師們的重點是，肥胖氣喘患者需要更仔細地追蹤，因為會比較難控制他們的氣喘，所以他們比較可能住院；我對於肥胖氣喘患者的建議是，對於自己的氣喘症狀要有所警惕，確保知道當症狀惡化時應該如何處置，且盡可能減重。
疾病控制與預防中心支持本研究。
Obese Patients With Asthma May Have Greater Risk for Hospitalization
By Laurie Barclay, MD
Medscape Medical News
September 4, 2008 — Obese patients with asthma may have a nearly 5 times greater risk for hospitalization than nonobese patients with asthma, according to the results of a cross-sectional study reported in the September issue of the Journal of Allergy and Clinical Immunology.
"The big finding here is that even after adjusting for risk factors, obese adults were nearly 5 times more likely to be hospitalized for their asthma," lead author David M. Mosen, PhD, MPH, from the Kaiser Permanente Center for Health Research in Portland, Oregon, said in a news release. "Given that nearly 30% of our country is obese, this study is yet another example of the long-term dangers of obesity, along with heart disease, diabetes, stroke, and dementia."
The study goal was to evaluate the association of obesity (body mass index [BMI] > 30 kg/m2), with quality-of-life scores, problems with asthma control, and asthma-related hospitalizations.
A random sample of 1113 members of a large integrated healthcare organization who were at least 35 years old and who had healthcare utilization suggestive of active asthma completed questionnaires at home. Study endpoints included the mini-Asthma Quality of Life Questionnaire, the Asthma Therapy Assessment Questionnaire, and self-reported asthma hospitalization.
The investigators also analyzed data concerning other variables known to affect asthma outcomes, including demographic factors, smoking status, use of oral corticosteroids or inhaled corticosteroid (ICS) in the past month, and evidence of gastroesophageal reflux disease (GERD). The association of BMI status with outcomes was determined using multiple logistic regression models.
Compared with adults with normal BMIs (<25 kg/m2), obese adults were more likely to report poor asthma-specific quality of life (odds ratio [OR], 2.8; 95% confidence interval [CI], 1.6 – 4.9), poor asthma control (OR, 2.7; 95% CI, 1.7 – 4.3), and a history of asthma-related hospitalizations (OR, 4.6; 95% CI, 1.4 – 14.4), even after adjustment for demographics, smoking status, oral corticosteroid use, evidence of GERD and ICS use.
On the basis of these findings, the study authors concluded that obesity is associated with worse asthma outcomes — especially an increased risk for asthma hospitalizations — even after accounting for other patient characteristics and treatment.
Limitations of this study include cross-sectional design, self-reported height and weight, lack of spirometry measurements, data not available regarding nonrespondents, and possible lack of generalizability to obese adults with asthma in other health delivery systems. The study authors recommend future research to develop, implement, and evaluate interventions to promote weight loss within the obese asthmatic population and to then determine the efficacy of such interventions regarding asthma-specific outcome measures.
"The take-home message of this study for clinicians is that obese people with asthma need to be followed more carefully because it's harder to control their asthma, so they are more likely to end up in the hospital," said study coauthor Michael Schatz, MD, chief of allergy at Kaiser Permanente San Diego Medical Center, California. "My advice for obese asthmatics is: be vigilant to keep your asthma symptoms in check, make sure you know what to do when your symptoms worsen, and do whatever you can to lose weight."
The Centers for Disease Control and Prevention supported this study.
J Allergy Clin Immunol. 2008;00:000-000.
[ 本帖最後由 goodcat1111 於 2008-9-14 15:42 編輯 ] |
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