Long-term prognosis of new adult-onset asthma in obese patients.

BACKGROUND

Obesity has been associated with poor outcomes of asthma in cross-sectional studies, but long-term effect of obesity on asthma remains unknown.

AIMS

To study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions.

METHODS

Patients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic body mass index (BMI) (<25 kg·m, 25-29.9 kg·m, ≥30 kg·m) and followed for 12 years as part of the Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records.

RESULTS

12 years after diagnosis, 86% of the patients who were obese (BMI ≥30 kg·m) at diagnosis remained obese. During the follow-up, no difference was found in weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more frequent use of OCS courses (46.9% 23.1%, p=0.028), were dispensed OCS more often (81.6% 56.9%, p=0.014) and at higher doses (median 1350 (interquartile range 280-3180) mg 600 (0-1650) mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, patients who were obese had more often one or more respiratory-related hospitalisations compared to normal-weight patients (38.8% 16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted OCS use and hospital admissions.

CONCLUSIONS

In adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.