Elsevier

Respiratory Medicine

Volume 107, Issue 9, September 2013, Pages 1356-1364
Respiratory Medicine

Underdiagnosis and overdiagnosis of asthma in the morbidly obese

https://doi.org/10.1016/j.rmed.2013.05.007Get rights and content
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Summary

Background

The prevalence of obesity and asthma has increased concurrently over the last decades, suggesting a link between obesity and asthma. However, asthma might not be adequately diagnosed in this population.

Aim

To investigate whether not only overdiagnosis but also underdiagnosis of asthma is present in an obese population.

Methods

Morbidly obese subjects with or without physician-diagnosed asthma were recruited from a pre-operative screening programme for bariatric surgery, and were characterized using an extensive diagnostic algorithm.

Results

473 subjects were screened; 220 met inclusion criteria, and 86 agreed to participate. Among the 32 participating subjects who had a physician diagnosis of asthma, reversible airway obstruction and/or bronchial hyperresponsiveness could only be detected in 19 patients (59%, 95% CI [0.41–0.76]), whereas in 13 patients (41%, 95% CI [0.24–0.50]) the diagnosis of asthma could not be confirmed (overdiagnosis). In contrast, in the remaining 54 patients, 17 (31%, 95% CI [0.20–0.46]) were newly diagnosed with asthma (underdiagnosis).

Conclusion

Besides overdiagnosis, there is also substantial underdiagnosis of asthma in the morbidly obese. Symptoms could be incorrectly ascribed to either obesity or asthma, and therefore also in the morbidly obese the diagnosis of asthma should also be based on pulmonary function testing.

Keywords

Asthma
Misdiagnosis
Obesity

Abbreviations

ACQ
Asthma Control Questionnaire
AQLQ
mini Asthma Quality of Life Questionnaire
BHR
bronchial hyperresponsiveness
BMI
body mass index
DLCO
diffusion capacity
ERV
expiratory reserve volume
ESS
Epworth Sleepiness Scale
FEF25–75
Forced expiratory flow at 25% point to the 75% point of Forced Vital Capacity
FeNO
Nitric Oxide
FEV1
forced expiratory volume in 1 s
FRC
functional residual capacity
FVC
forced vital capacity
GERD
Gastro oesophageal reflux disease
ICS
inhaled corticosteroid
IOS
impulse oscillometry
OSAS
obstructive sleep apnea syndrome
RV
residual volume
SPT
skin prick test
TLC
total lung capacity

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Work performed at: Sint Franciscus Gasthuis, Rotterdam, The Netherlands.