Abstract
Background Obesity is a common co-morbidity in asthma and associated with poorer asthma control, more frequent/severe exacerbations, and reduced response to asthma pharmacotherapy.
Objective This review aims to compare use of all classes of asthma medications in obese (BMI≥30 kg·m−2) versus healthy weight (BMI<25 kg·m−2) subjects with asthma.
Design Databases including CINAHL, Cochrane, EMBASE, and MEDLINE were searched for English language studies up to July 2019 that recorded medication use or dose in obese and healthy weight adults with asthma. A critical appraisal checklist was utilised for scrutinising methodologic quality of eligible studies. Meta-analysis was performed and heterogeneity was examined with the use of the χ2 test. This review was conducted based on a published protocol (PROSPERO: CRD42020148671).
Results Meta-analysis showed that obese subjects are more likely to use asthma medications including; short-acting β2-agonists [odds ratio (OR)=1.75; 95% CI:1.17, 2.60; p=0.006, I2=41%] and maintenance oral corticosteroids (OR=1.86; 95% CI:1.49, 2.31; p<0.001, I2=0%) compared to healthy weight subjects. Inhaled corticosteroid dose (µg·day−1) was significantly higher in obese subjects (mean difference=208.14; 95% CI:107.01, 309.27; p<0.001, I2=74%). FEV1% predicted was significantly lower in obese subjects (mean difference=−5.32%; 95% CI:−6.75, −3.89; p<0.001, I2=42%), however, no significant differences were observed in FEV1/FVC% between groups.
Conclusions We found that obese subjects with asthma have higher use of all included asthma medication classes and higher ICS doses than healthy weight asthma subjects, despite lower FEV1 and a similar FEV1/FVC%. A better understanding of the factors driving increased medication use is required to improve outcomes in this subgroup of asthmatics.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Miss. Thompson has nothing to disclose.
Conflict of interest: Mr. Eslick has nothing to disclose.
Conflict of interest: Dr. Berthon has nothing to disclose.
Conflict of interest: Professor. Wood has nothing to disclose.
- Received March 10, 2020.
- Accepted August 31, 2020.
- Copyright ©ERS 2020
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