Rodrigo Gustavo J, Plaza Vicente
Departamento de Emergencia, Hospital Central de las FF.AA, Av. 8 de Octubre 3020, Montevideo 11600, Uruguay.
Chest. 2007 Nov;132(5):1513-9. doi: 10.1378/chest.07-0936. Epub 2007 Sep 21.
In acute asthma (AA), overweight/obesity (body mass index [BMI]>or=25 kg/m2) have been related to poorer outcomes and higher risk of complications.
We designed a prospective cohort study to determine if overweight/obese adults with severe episodes of AA require longer duration of emergency department (ED) treatment and have higher hospitalization rates compared with underweight/normal asthmatics (BMI<25 kg/m2). All patients received inhaled albuterol (maximum 6 h). Patients were discharged or admitted according to standard accepted criteria. The weight and height of each patient were measured during the ED stay.
Four hundred twenty-six patients (mean, 33.4+/-11.5 years [+/-SD]; 63% women) with severe exacerbations (FEV1, 28.2+/-11.9% of predicted) were enrolled. One hundred sixty-three patients (38.3%) were classified as overweight/obese. Patients with BMI>or=25 kg/m2 showed significant increases in length of ED stay (2.3 h vs 1.9 h, p=0.01) and rate of hospitalization (13.7% vs 6.8%, p=0.02), despite adjustments for other confounding variables. They also presented a higher rate of use of inhaled steroids and theophylline within the past 7 days. At the end of treatment, overweight/obese patients displayed more wheezing. Multivariate analysis demonstrated that BMI>or=25 kg/m2 resulted unrelated to final change in peak expiratory flow from baseline. By contrast, BMI>or=25 kg/m2 was related with duration of ED treatment (p=0.002).
Overweight/obese patients were admitted to the hospital more frequently than underweight/normal patients. This may reflect a difference in the perception of dyspnea, or it may reflect an underlying difference in asthma severity between the two groups.
在急性哮喘（AA）中，超重/肥胖（体重指数[BMI]≥25kg/m²）与较差的预后及更高的并发症风险相关。
我们设计了一项前瞻性队列研究，以确定与体重过轻/正常的哮喘患者（BMI<25kg/m²）相比，患有严重AA发作的超重/肥胖成年人是否需要更长时间的急诊科（ED）治疗以及具有更高的住院率。所有患者均接受吸入沙丁胺醇（最长6小时）治疗。患者根据公认的标准出院或入院。在患者于ED留观期间测量其体重和身高。
纳入了426例严重加重（第1秒用力呼气容积[FEV₁]为预测值的28.2%±11.9%）的患者（平均年龄33.4±11.5岁[±标准差]；63%为女性）。163例患者（38.3%）被分类为超重/肥胖。尽管对其他混杂变量进行了调整，但BMI≥25kg/m²的患者在ED的留观时间（2.3小时对1.9小时，p=0.01）和住院率（13.7%对6.8%，p=0.02）显著增加。他们在过去7天内吸入类固醇和茶碱的使用率也更高。治疗结束时，超重/肥胖患者喘息更多。多变量分析表明，BMI≥25kg/m²与呼气峰值流速相对于基线的最终变化无关。相比之下，BMI≥25kg/m²与ED治疗时间相关（p=约0.002）。
超重/肥胖患者比体重过轻/正常患者更频繁地入院。这可能反映了对呼吸困难感知的差异，或者可能反映了两组之间哮喘严重程度的潜在差异。
