Influence of weight status in the response to Step-2 maintenance therapies in children with asthma
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Introduction Overweight children with asthma may display impaired response to inhaled corticosteroids (ICS), possibly due to non-eosinophilic inflammation or weight-related lung compression; these mechanisms may differentially affect response to ICS and leukotriene receptor antagonists (LTRAs). We assessed whether weight status modified the response to low-dose ICS and LTRA Step-2 monotherapy. Methods A historical cohort study from clinical data linked to administrative databases was conducted among children aged 2–18 years with specialist-diagnosed asthma who were initiating or continuing a Step-2 monotherapy from 2000 to 2007 at the Montreal Children’s Hospital Asthma Centre. The outcome was time-to-management failure defined as any step-up in therapy, acute care visit, hospitalisation or oral corticosteroids for asthma, whichever occurred first. The independent and joint effects of weight status (body mass index [BMI] percentile) and time-varying treatment on time-to-management failure were estimated with marginal structural Cox models. The likelihood ratio test (LRT) and relative excess risk due to interaction (RERI) were computed to assess treatment effect modification by weight status on the multiplicative and additive scales. Results Of the 433 and 85 visits with a low-dose ICS and LTRA prescription, respectively, 388 management failures occurred over 14 529 visit-weeks of follow-up. Children using LTRA compared with low-dose ICS tended to have an overall higher risk of early management failure (HR 1.52; 95% CI 0.72 to 3.22). Irrespective of treatment, the hazard of management failure increased by 5% (HR 1.05; 95% CI 1.01 to 1.10) for every 10-unit increase in BMI percentile. An additional hazard reduction of 17% (HR 0.83; 95% CI 0.70 to 0.99) was observed for every 10-unit increase in BMI percentile among LTRA users, but not for ICS (HR 0.95; 95% CI 0.86 to 1.04). The LRT indicated a departure from exact multiplicativity (p<0.0001), and the RERIs for ICS and LTRA were −0.05 (95% CI −0.14 to 0.05) and −0.52 (95% CI −1.76 to 0.71). Conclusions Weight status was associated with earlier time-to-management failure in children prescribed Step-2 therapy. This hypothesis-generating study suggests that LTRA response increases in children with higher BMI percentiles, although further research is warranted to confirm findings.Objective To evaluate the impact of pretransplant body mass index on graft failure and mortality in Japanese patients undergoing living kidney transplant. Methods A cohort of 888 living kidney transplant recipients who received standard immunosuppressive therapy between 2000 and 2013 were identified from the Japan Academic Consortium of Kidney Transplantation database. Pretransplant body mass index was divided into three categories according to the following tertiles: <19.4, 19.5–22.2 and ≥22.3 kg/m 2 . A multivariable time‐to‐event analysis was carried out. Results Estimated hazard ratios of the body mass index effects regarding graft failure were 1.62 (95% confidence interval 0.83–3.18) for the first tertile and 2.20 (95% confidence interval 1.24–3.90) for the third tertile. Patient mortality was 1.21 (95% confidence interval 0.32–4.54) for the first tertile and 1.52 (95% confidence interval 0.56–4.13) for the third tertile. In a subgroup analysis, the effects of body mass index according to sex were substantially heterogeneous ( P = 0.029 for interaction). Pretransplant body mass index had a non‐linear J‐shaped association with graft failure that resulted from qualitative interaction between body mass index and the recipient's sex. Conclusions Sex differences and interaction effects must be considered when evaluating the effects of pretransplant body mass index on post‐transplant outcomes in Japanese patients undergoing living kidney transplant.
Mass index
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Background: The prevalence of both obesity and asthma has risen in recent years. We sought to investigate whether obesity may be related to asthma.
Materials and methods: In this analytical study, 177 patients with asthma were enrolled. Obesity was defined as a body mass index (BMI) greater than 30. Asthma severity was defined by using the National Heart Lung and Blood Institute 1997 guidelines.
Results: Of the 177 patients, there were 80 males and 97 females. 38.4 percent of the sample was obese. There is no significant relationship between BMI and asthma severity (P=0.76) but as established by Pearsons correlation coefficient a positive and significant correlation is present between BMI and FEV1/FVC values (r=0.32 P=0.0001). Females with asthma were significantly more overweight than males (p = 0.001).
Conclusions: In our study, there was a significant correlation between body mass index and sex of patients with asthma. Women had the highest percentages of asthma compared to men, and had a higher body mass index than men.
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Background: Asthma in adulthood could be programmed in early life. However, the number of cohort studies following the development of asthma from childhood up to adulthood is so far limited and the findings have been contradictory.
Objective: To evaluate the development of asthma over time in a cohort born in the mid 1970-ies.
Material & Methods: A population-based, non-selected birth cohort comprising 1,701 consecutively born children at a University Hospital in Southeast Sweden. At the age of 6–7 and 10–11 years of age an asthma diagnosis was confirmed by parental questionnaires, telephone check-ups and the review of available medical records. Information on dispensed asthma medication (inhaled corticosteroids and/or leucotriene antagonists) at the ages of 32-34 years was collected from the Swedish Prescribed Drug Register after linkage of data at an individual level.
Results: In all, 1,661 individuals (97.6%) of the original birth cohort could be linked to the Swedish Prescribed Drug Register and 48 individuals were diagnosed with asthma at the two follow-ups in childhood. At the age of 32-34 years, 60 individuals were dispensed inhaled corticosteroids or leucotriene antagonists. Out of those, 49 individuals had not been diagnosed with asthma at the check-ups during childhood.
Conclusion: The majority of the individuals with asthma in childhood had not been dispensed asthma medication in adulthood. The findings suggest that a major part of the individuals with asthma medication at the age of 32-34 years had developed asthma during or after adolescence.
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Medical record
Asthma medication
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Obesity paradox
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Using data on weight and height at 6 and 11 months of age and primary care electronic health records data from 1960 children participating in the Wheezing Illnesses Study Leidsche Rijn birth cohort study, we found that body mass index at 6 and 11 months of age was not associated with otitis media occurrence during the first 4 years of life.
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Background: Atrial Fibrillation (AF) ablations are performed in pts of all age groups. No data exists on the outcomes or Quality of Life (QOL) specific to the octogenarian population undergoing this procedure. We hypothesize the outcomes and risks would not be too dissimilar when compared to a younger cohort between 65-79 years. Methods: From a retrospective database we selected octogenarian pts compared to an age and sex matched control group, ages 65-79. Pre-ablation tests were performed as well as quality of life (QoL) and symptom inventories. Results of the ablation procedure, follow up QoL and symptom inventories, peri-procedure morbidity and freedom from AF or control of AF with anti-arrhythmic agents were compared between the 2 groups. Results: During follow-up (mean 2.3 ± 2.2 years), AF elimination (70% vs 81%, p 0.942) and AF control including those on antiarrhythmic agents (86% vs 86%, p 0.249) were compared. Conclusion: Outcomes of ablation in the octogenarians are highly favorable with no increase in procedural complications. Improvement in QOL scores is impressive in patients with advancing age. Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AF Comparison of variables between the Young-Old and the Octagenerian cohort of patients undergoing ablation of drug-refractory AF
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Background and Objectives: Asthma and obesity have a considerable impact on public health and their prevalence has increased in recent years. The association between asthma severity and obesity has been increasingly established. The objective of this present study is to confirm the relationship between asthma severity and body mass index or obesity. Patients and Methods: This cross sectional descriptive study was conducted at Allergy and Asthma center and Sulaimani Internal Teaching Hospital. One hundred patients (66 female and 34 male), aged between 16 - 79 years old who were previously diagnosed with asthma were included in this study. US dietary guideline was used to categorize body mass index groups. Asthma severity was classified according to the criteria of the global initiative for asthma guidelines in 2008. Statistical package for social science (version 21) was used for statistical analysis. Results: The mean + standard deviation of body mass index and global initiative of asthma for asthma severity classification were 28.8 + 7.3 and 4.1 + 1.1, respectively. The positive correlation coefficient was found between body mass index and asthma severity classification of global Initiative for Asthma (r=0.252). Therefore, this positive correlation was statistically significant (p=0.011) independent on sex and ages. The coefficient of body mass index was 0.035. Thus, this means that for one value increase in body mass index, a 3.5% increase in Asthma severity class would be expected. Conclusion: Obesity was positively correlated with asthma severity. This correlation suggests that obesity may be a potential modifiable risk factor for asthma exacerbation
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Objective:To explore the relation of the body mass index(BMI) with asthma and its severity in adults.Methods:A total of 83 patients with asthma and 32 control subjects were studied.We analysed the relation of BMI and asthma,the relation of BMI and severity of asthma in all patients,respectively.Results:BMI was higher in asthma groups than in controls(25.19±4.09 vs 22.58±3.32).The values of BMI was(23.24±4.25) kg/m~2 in mild persistent group,(25.25±3.25) kg/m~2 in moderate persistent group,(27.52±4.74) kg/m~2 in severe persistent group.There were significant differences between asthma patients group and the controls,as well as between the mild, moderate and severe persistent patients.Conclusion:BMI is related to asthma and the severity of asthma.
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Circumference
Cross-sectional study
Waist-to-height ratio
Waist–hip ratio
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