Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA.
COPD. 2011 Aug;8(4):275-84. doi: 10.3109/15412555.2011.586660. Epub 2011 Aug 2.
There is little data about the combined effects of COPD and obesity. We compared dyspnea, health-related quality of life (HRQoL), exacerbations, and inhaled medication use among patients who are overweight and obese to those of normal weight with COPD.
We performed secondary data analysis on 364 Veterans with COPD. We categorized subjects by body mass index (BMI). We assessed dyspnea using the Medical Research Council (MRC) dyspnea scale and HRQoL using the St. George's Respiratory Questionnaire. We identified treatment for an exacerbation and inhaled medication use in the past year. We used multiple logistic and linear regression models as appropriate, with adjustment for age, COPD severity, smoking status, and co-morbidities.
The majority of our population was male (n = 355, 98%) and either overweight (n = 115, 32%) or obese (n = 138, 38%). Obese and overweight subjects had better lung function (obese: mean FEV(1) 55.4% ±19.9% predicted, overweight: mean FEV(1) 50.0% ±20.4% predicted) than normal weight subjects (mean FEV(1) 44.2% ±19.4% predicted), yet obese subjects reported increased dyspnea [adjusted OR of MRC score ≥2 = 4.91 (95% CI 1.80, 13.39], poorer HRQoL, and were prescribed more inhaled medications than normal weight subjects. There was no difference in any outcome between overweight and normal weight patients.
Despite having less severe lung disease, obese patients reported increased dyspnea and poorer HRQoL than normal weight patients. The greater number of inhaled medications prescribed for obese patients may represent overuse. Obese patients with COPD likely need alternative strategies for symptom control in addition to those currently recommended.
关于 COPD 和肥胖的综合影响的数据较少。我们比较了超重和肥胖的 COPD 患者与体重正常的患者之间的呼吸困难、健康相关生活质量（HRQoL）、加重和吸入药物使用情况。
我们对 364 名患有 COPD 的退伍军人进行了二次数据分析。我们根据体重指数（BMI）对受试者进行分类。我们使用医学研究委员会（MRC）呼吸困难量表评估呼吸困难，使用圣乔治呼吸问卷评估 HRQoL。我们确定了过去一年中治疗加重和吸入药物的使用情况。我们使用了适当的多逻辑和线性回归模型，并根据年龄、COPD 严重程度、吸烟状况和合并症进行了调整。
我们的研究人群大多数为男性（n=355，98%），要么超重（n=115，32%），要么肥胖（n=138，38%）。肥胖和超重患者的肺功能更好（肥胖：平均 FEV1 为 55.4%±19.9%预计值，超重：平均 FEV1 为 50.0%±20.4%预计值），而体重正常患者的平均 FEV1 为 44.2%±19.4%预计值），但肥胖患者报告呼吸困难增加[调整后的 MRC 评分≥2 的比值比为 4.91（95%CI 1.80，13.39]，HRQoL 更差，并且比体重正常患者开的吸入药物更多。超重和体重正常患者在任何结果上均无差异。
尽管肥胖患者的肺部疾病较轻，但他们报告的呼吸困难和 HRQoL 比体重正常患者更差。为肥胖患者开具的吸入药物数量更多可能代表过度使用。肥胖的 COPD 患者可能需要除了目前推荐的策略之外，还需要有其他的症状控制策略。
