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OBESITY & ASTHMA A Specific Phenotype? Andrea Lessard, BSc; Helene Turcotte, MSc; Yum Cormier, MD; and Louis-Philippe Boulet, MD, FCCP Source: CHEST – Official Publication of the American College of Chest Physician Vol.134, No.2, p317-323, 2008
BACKGROUND ,[object Object],[object Object]
OBJECTIVES ,[object Object],[object Object],[object Object],[object Object],[object Object]
Keywords: ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
METHODOLOGY ,[object Object],[object Object],[object Object],[object Object],[object Object]
Exclusion! ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Skin-prick Test: ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object]
ANALYSIS OF RESULTS  ,[object Object],[object Object],[object Object]
Table 1 – Demographic & Medical Characteristics 0.78  ± 0.06 0.78  ± 0.07 σ  waist-hip ratio 77.7 ± 8.9 79.0 ± 7.2 σ  waist circ. 17 (77.3) 22 (100) Subj. w/ atopy 22.8  ± 2.4 23.3  ±1.8 BMI 11 (50) 7 (31.2) Ex. smokers 1 (4.5) 0 Subj. w/ GERD 0 0 Subj. w/ DM 2 2 (9) 0 Subj. w/ HPN 17.5  ± 12.1 18.6  ± 13.8 Asthma duration, yr 22 (100) 15 (68) Female gender 43.7  ± 13.3 32.5  ± 10.0 Age SABAs + ICS  (n=22) SABAs  (n=22) VARIABLES NON-OBESE
15 (68.2) 21 (95.5) Subj. w/ atopy 107.3 ± 12.4 109.5 ± 16.2 σ  waist circ. 0.88  ± 0.09 0.88  ± 0.09 σ  waist-hip ratio 37.0  ± 5.8 37.2  ± 5.7 BMI 8 (36.4) 6 (27.3) Ex. smokers 3 (13.6) 2 (9) Subj. w/ GERD 2 (9) 1 (4.5) Subj. w/ DM 2 4 (18) 2 (9) Subj. w/ HPN 24.7  ± 13.6 16.7  ± 8.7 Asthma duration, yr 22 (100) 15 (68) Female gender 44.1  ± 13.5 36.5  ± 13.0 Age SABAs + ICS  (n=22) SABAs  (n=22) VARIABLES OBESE
[object Object],[object Object],[object Object],[object Object],[object Object]
Total ACQ Scores ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object]
Table 2 – Spirometry, Lung Volumes, & Methacholine Test Results 106  ±   20 108  ±  25 σ  IC % predicted 117  ± 33 108  ±  44 σ  ERV % predicted 1.03 (0.66-1.61) 1.32 (0.79-2.20) PC 20  mg/mL 5.7  ±  4.6 6.5  ±  7.0 σ  change % predicted reversibble FEV1 119  ± 28 125  ±  33 σ  RV % predicted 115  ± 15 113  ±  18 σ  TLC % predicted 56  ± 24 73  ±  23 σ  FEF 25-75%  % predicted 88 ± 11 92 ± 10 σ  FEV/FVC 101  ± 15 111  ±  15 σ  FVC % predicted 90 ± 17 98 ± 13 σ  FEV1 % predicted SABAs + ICS  (n=22) SABAs  (n=22) VARIABLES NON-OBESE
0.96 (0.55-1.68) 1.36 (0.77-1.61) PC 20  mg/mL 6.3  ± 5.6 4.9 ± 5.2 σ  change % predicted reversibble FEV1 127  ± 24 124 ± 24 σ  IC % predicted 67  ± 61 78 ± 36 σ  ERV % predicted 117  ±  25 90 ± 23 σ  RV % predicted 109  ± 12 104 ± 13 σ  TLC % predicted 50  ± 22 79 ± 25 σ  FEF 25-75%  % predicted 90 ± 12 94 ± 7 σ  FEV/FVC 92 ± 13 111  ± 18 σ  FVC % predicted 81 ± 16 100 ± 18 σ  FEV1 % predicted SABAs + ICS  (n=22) SABAs  (n=22) VARIABLES OBESE
Methacholine Challenge: ,[object Object],[object Object],[object Object]
[object Object],[object Object]
Table 3: Differential Cell Count in Induced Sputum 1.9 (2.1) 10.5 (17.1) Metachromatic cells 40.9 (17.1) 31.6 (21.8) Neutrophils 1.5 (1.3) 1.3 (0.9) Lymphocystes 40.6 (19.4) 54.5 (30.1) Macrophages 15.2 (19.6) 2.6 (3.7) Eosinophils  SABAs + ICS   SABAs  VARIABLES NON-OBESE
3.2 (4.1) 3.6 (3) Metachromatic cells 41.5 (26.7) 48.6 (21.3) Neutrophils 1.5 (1.0) 1.3 (1.2) Lymphocystes 48.7 (23.9) 42.1 (19.8) Macrophages 5.1 (8.8) 4.6 (12.9) Eosinophils  SABAs + ICS   SABAs  VARIABLES OBESE
2.4  ± 3.4 mg/L 4.3  ± 3.2 mg/L σ  serum CRP  (p=0.001) 3.1  ± 0.6 g/L 3.7  ± 0.7 g/L Serum level of Fibrinogen (p=0.0002) 219  ± 245 IU/mL 216  ± 367 IU/mL Serum IgE (p=0.96) NON-OBESE OBESE
[object Object],[object Object]
DISCUSSION ,[object Object]
[object Object]
[object Object]
[object Object]
[object Object],[object Object]
LIMITATION OF THE STUDY ,[object Object],[object Object]
[object Object],[object Object],[object Object]
[object Object],[object Object],CONCLUSION
RECOMMENDATIONS ,[object Object],[object Object]
[object Object],[object Object]
thank you!

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Obesity & Asthma Journal

  • 1. OBESITY & ASTHMA A Specific Phenotype? Andrea Lessard, BSc; Helene Turcotte, MSc; Yum Cormier, MD; and Louis-Philippe Boulet, MD, FCCP Source: CHEST – Official Publication of the American College of Chest Physician Vol.134, No.2, p317-323, 2008
  • 2.
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  • 4.
  • 5.
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  • 9.
  • 10.
  • 11.
  • 12.
  • 13. Table 1 – Demographic & Medical Characteristics 0.78 ± 0.06 0.78 ± 0.07 σ waist-hip ratio 77.7 ± 8.9 79.0 ± 7.2 σ waist circ. 17 (77.3) 22 (100) Subj. w/ atopy 22.8 ± 2.4 23.3 ±1.8 BMI 11 (50) 7 (31.2) Ex. smokers 1 (4.5) 0 Subj. w/ GERD 0 0 Subj. w/ DM 2 2 (9) 0 Subj. w/ HPN 17.5 ± 12.1 18.6 ± 13.8 Asthma duration, yr 22 (100) 15 (68) Female gender 43.7 ± 13.3 32.5 ± 10.0 Age SABAs + ICS (n=22) SABAs (n=22) VARIABLES NON-OBESE
  • 14. 15 (68.2) 21 (95.5) Subj. w/ atopy 107.3 ± 12.4 109.5 ± 16.2 σ waist circ. 0.88 ± 0.09 0.88 ± 0.09 σ waist-hip ratio 37.0 ± 5.8 37.2 ± 5.7 BMI 8 (36.4) 6 (27.3) Ex. smokers 3 (13.6) 2 (9) Subj. w/ GERD 2 (9) 1 (4.5) Subj. w/ DM 2 4 (18) 2 (9) Subj. w/ HPN 24.7 ± 13.6 16.7 ± 8.7 Asthma duration, yr 22 (100) 15 (68) Female gender 44.1 ± 13.5 36.5 ± 13.0 Age SABAs + ICS (n=22) SABAs (n=22) VARIABLES OBESE
  • 15.
  • 16.
  • 17.
  • 18. Table 2 – Spirometry, Lung Volumes, & Methacholine Test Results 106 ± 20 108 ± 25 σ IC % predicted 117 ± 33 108 ± 44 σ ERV % predicted 1.03 (0.66-1.61) 1.32 (0.79-2.20) PC 20 mg/mL 5.7 ± 4.6 6.5 ± 7.0 σ change % predicted reversibble FEV1 119 ± 28 125 ± 33 σ RV % predicted 115 ± 15 113 ± 18 σ TLC % predicted 56 ± 24 73 ± 23 σ FEF 25-75% % predicted 88 ± 11 92 ± 10 σ FEV/FVC 101 ± 15 111 ± 15 σ FVC % predicted 90 ± 17 98 ± 13 σ FEV1 % predicted SABAs + ICS (n=22) SABAs (n=22) VARIABLES NON-OBESE
  • 19. 0.96 (0.55-1.68) 1.36 (0.77-1.61) PC 20 mg/mL 6.3 ± 5.6 4.9 ± 5.2 σ change % predicted reversibble FEV1 127 ± 24 124 ± 24 σ IC % predicted 67 ± 61 78 ± 36 σ ERV % predicted 117 ± 25 90 ± 23 σ RV % predicted 109 ± 12 104 ± 13 σ TLC % predicted 50 ± 22 79 ± 25 σ FEF 25-75% % predicted 90 ± 12 94 ± 7 σ FEV/FVC 92 ± 13 111 ± 18 σ FVC % predicted 81 ± 16 100 ± 18 σ FEV1 % predicted SABAs + ICS (n=22) SABAs (n=22) VARIABLES OBESE
  • 20.
  • 21.
  • 22. Table 3: Differential Cell Count in Induced Sputum 1.9 (2.1) 10.5 (17.1) Metachromatic cells 40.9 (17.1) 31.6 (21.8) Neutrophils 1.5 (1.3) 1.3 (0.9) Lymphocystes 40.6 (19.4) 54.5 (30.1) Macrophages 15.2 (19.6) 2.6 (3.7) Eosinophils SABAs + ICS SABAs VARIABLES NON-OBESE
  • 23. 3.2 (4.1) 3.6 (3) Metachromatic cells 41.5 (26.7) 48.6 (21.3) Neutrophils 1.5 (1.0) 1.3 (1.2) Lymphocystes 48.7 (23.9) 42.1 (19.8) Macrophages 5.1 (8.8) 4.6 (12.9) Eosinophils SABAs + ICS SABAs VARIABLES OBESE
  • 24. 2.4 ± 3.4 mg/L 4.3 ± 3.2 mg/L σ serum CRP (p=0.001) 3.1 ± 0.6 g/L 3.7 ± 0.7 g/L Serum level of Fibrinogen (p=0.0002) 219 ± 245 IU/mL 216 ± 367 IU/mL Serum IgE (p=0.96) NON-OBESE OBESE
  • 25.
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  • 31.
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  • 35.