Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study

doi:10.1136/bmj.320.7238.827

BMJ 2000;320:827-832 ( 25 March )

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Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study

Brita Stenius-Aarniala, professor of pulmonary medicine, ^a Tuija Poussa, statistics consultant, ^b Johanna Kvarnström, medical student, ^a Eeva-Liisa Grönlund, consultant in pulmonary medicine, ^c Mikko Ylikahri, licentiate in medicine, ^a Pertti Mustajoki, consultant in pulmonary medicine. ^c

^a Division of Pulmonary Medicine and Allergology, Helsinki University Central Hospital, FIN-00029 HYKS, Helsinki, Finland, ^b STAT-Consulting, Takojankatu 15 B, FIN-33540 Tampere, Finland, ^c Peijas Hospital, Sairaalakatu 1, FIN-01400 Vantaa, Finland

Correspondence to: B Stenius-Aarniala, Department of Medicine, PL 340 Helsinki, University Central Hospital, FIN-00029 HYKS, Finland bstenius{at}cc.helsinki.fi

Objective: To investigate the influence of weight reductionon obese patients withasthma.
Design: Open study, two randomised parallelgroups.
Setting: Private outpatients centre, Helsinki,Finland.
Participants: Two groups of 19 obese patients with asthma(body mass index (kg/m²) 30 to 42) recruited through newspaperadvertisements.
Intervention: Supervised weight reduction programme including8 week very low energydiet.
Main outcome measures: Body weight, morning peak expiratory flow(PEF), forced vital capacity (FVC), forced expiratory volume inone second (FEV₁); and also asthma symptoms, number of acute episodes,courses of oral steroids, health status (quality oflife).
Results: At the end of the weight reducing programme,the participants in the treatment group had lost a mean of 14.5%of their pretreatment weight, the controls 0.3%. The correspondingfigures after one year were 11.3% and a weight gain of 2.2%. Afterthe 8 week dieting period the difference in changes in percentageof predicted FEV₁ from baseline in the treatment and control groupswas 7.2% (95% confidence interval 1.9% to 12.5%, P=0.009). Thecorresponding difference in the changes in FVC was 8.6% (4.8%to 12.5%, P<0.0001). After one year the differences in the changesin the two groups were still significant: 7.6% for FEV₁ (1.5%to 13.8%, P=0.02) and 7.6% for FVC (3.5% to 11.8%, P=0.001). Bythe end of the weight reduction programme, reduction in dyspnoeawas 13 mm (on a visual analogue scale 0 mm to 100 mm) in the treatmentgroup and 1 mm in the control group (P=0.02). The reduction ofrescue medication was 1.2 and 0.1 doses respectively (P=0.03).After one year the differences in the changes between the twogroups were $-$ 12 for symptom scores (range $-$ 1 to $-$ 22, P=0.04) and $-$ 10 for total scores ( $-$ 18 to $-$ 1, P=0.02). The median number ofexacerbations in the treatment group was 1 (0-4) and in the controls4 (0-7), P=0.001.
Conclusion: Weight reduction in obese patients with asthmaimproves lung function, symptoms, morbidity, and healthstatus.

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Rodriguez, M. A., Winkleby, M. A., Ahn, D., Sundquist, J., Kraemer, H. C. (2002). Identification of Population Subgroups of Children and Adolescents With High Asthma Prevalence: Findings From the Third National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med 156: 269-275 [Abstract] [Full text]
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Chen, Y., Dales, R., Tang, M., Krewski, D. (2002). Chen et al. Respond to "Obesity and Asthma". Am J Epidemiol 155: 201-202 [Full text]
Chinn, S, Rona, R J (2001). Can the increase in body mass index explain the rising trend in asthma in children?. Thorax 56: 845-850 [Abstract] [Full text]
Tantisira, K G, Weiss, S T (2001). Complex interactions in complex traits: obesity and asthma. Thorax 56: ii64-74 [Full text]
Young, S. Y. N., Gunzenhauser, J. D., Malone, K. E., McTiernan, A. (2001). Body Mass Index and Asthma in the Military Population of the Northwestern United States. Arch Intern Med 161: 1605-1611 [Abstract] [Full text]
Beilby, J. (2000). Weight loss in obese patients with asthma improved lung function and health status. Evid. Based Med. 5: 170-170 [Full text]
Hakala, K., Stenius-Aarniala, B., Sovijarvi, A. (2000). Effects of Weight Loss on Peak Flow Variability, Airways Obstruction, and Lung Volumes in Obese Patients With Asthma. Chest 118: 1315-1321 [Abstract] [Full text]
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Moudgil, H. (2000). Prevalence of obesity in asthmatic adults. BMJ 321: 448a-448 [Full text]
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