Characterization of Self-reported Asthma in Morbidly Obese Women

1. Presented By: Alton R. Johnson Jr. Characterization of Self-reported Asthma in Morbidly Obese Women

2. Outline • Asthma • Pathophysiology, epidemiology, & diagnosis • Obesity • Definition, trends, morbidity • Obesity & asthma association • Supporting evidence • Summer Research Project

3. Pathophysiology Asthma Inflammation Airway Hyperresponsiveness Airway Obstruction Clinical symptoms

4. Epidemology of asthma • One of the most common chronic respiratory diseases • affects approx. 7% of population (22 million) (CDC, 2010) • 27% are children (>6 million) (CDC, 2010) • Associated with significant morbidity • African American children have a 250% higher hospitalization rate and a 500% higher death rate (CDC, 2010)

5. Asthma: Prevalence • Prevalence = (# of people with the disease) / (# of people at risk for disease + # of people with the disease) • Increasing prevalence over past 20 years (NAEPP, 2010) • Significant disparity.

6. Obesity

7. Obesity Trends* Among U.S. AdultsBRFSS,1990, 2008 (*BMI 30, or about 30 lbs. overweight for 5’4” person) 2008 1990 No Data <10% 10%–14% 15%–19% 20%–24% 25%–29% ≥30%

8. Obesity and Asthma • Cross-sectional studies • Increased prevalence of asthma in obese patients • Obesity associated with worst asthma control and increased morbidity (severe symptoms) • Longitudinal studies • Asthma risk increases by 50 % in overweight and obese people • AHR is associated with increased BMI

9. Obesity associated with increased risk of asthma Beuther and Sutherland 2007

10. Obesity and Asthma • Possible explanations: • Causal link • Obesity leads to increased risk of asthma • Inflammatory pathway • Mechanical pathway • Coincidental • Epiphenomenon • Shared risk factors (i.e. genetic, environmental) • Diagnostic bias

11. Effects of obesity on asthma control/severity • Controversial findings • Some studies showing worst asthma symptoms in obese patients (Schacteret.al. 2001) • Others have not (Clerisme-Beatyet.al. 2009) • Limited by use of self-report or questionnaire to diagnose asthma

12. Project Importance • Obesity is associated with changes in lung volumes which may mimic asthma. • It is unclear whether the asthma phenotype is different in obese patients

13. Objective • To examine differences in pulmonary function profile, respiratory symptoms, and quality of life in morbidly obese women based on self-reported asthma.

14. Recruitment • 53 participants were recruited to participate in the study. • 11 were excluded based on gender, leaving 42 women in the final analysis.

15. Results

16. Baseline Demographics

17. General Health Survey Results

18. Respiratory Questionnaire

19. Pulmonary Function Profile

20. Air Hyperresponsiveness • 24 participants (6 asthmatics, 18 non-asthmatics) • 60% asthmatics had positive AHR • 40% non-asthmatics had positive AHR

21. Conclusions • Both Groups: • Decreased quality of life • Increased reports of respiratory symptoms • Trend for lower FEV1/FVC • Asthmatics: • Significantly more respiratory complaints • Lower quality of life • Symptoms rather than objective differences in respiratory function may guide the diagnosis of asthma in this population

22. Limitation • It is unclear whether these findings apply to men or patients with less severe obesity.

26. Acknowledgements • Emmanuelle Clerisme-Beaty, MD MHS • Mercedes Proctor, BA • Andrew Bilderback, MS • Cynthia Rand, PhD • FlonaRedway, PhD • Denise Guise Funding: • NIH/NHLBI grant R25 HL084762, Johns Hopkins University • NIH grant K12RR01767, Johns Hopkins University • NIH-NIGMS RISE Grant, R25 GM059244-09, Barry University

27. Questions