Higher BMI is associated with worse asthma control and quality of life but not asthma severity
Open accessAbstract
Asthma and obesity tend to co-occur, but relatively few studies have linked obesity, measured using body mass index (BMI), to clinically relevant measures of asthma morbidity. This study assessed BMI in a Canadian sample of asthma outpatients, and evaluated associations between BMI and levels of asthma severity, asthma control, and asthma-related quality of life. A total of 382 adult asthma patients underwent demographic and medical history interviews on the day of their clinic visit. Patients' self-reported height and weight were used to calculate BMI (kg/m(2)). Asthma severity was classified according the GINA (2002) guidelines. Patients completed the Asthma Control (ACQ) and Asthma Quality of Life (AQLQ) Questionnaires and underwent standard pulmonary testing (spirometry). A total of 139 (36%) patients had a normal BMI; 149 (39%) patients were overweight; and 94 (25%) patients were obese. There was no relationship between BMI and asthma severity when controlling for age and sex. Patients with higher BMI scores had higher ACQ and lower AQLQ scores, independent of age, sex and asthma severity. Results identify higher BMI and obesity as potential behavioral factors related to worse asthma control and quality of life, but not asthma severity, and suggest important avenues for asthma management and control initiatives.
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A higher proportion of people with asthma seem to have overweight or obese BMI and weight loss intervention studies have been associated with improvements in asthma symptoms.
“For instance, a higher proportion of people with asthma seem to have overweight or obese BMI67 and weight loss intervention studies have been associated with improvements in asthma symptoms.68”
From A systematic review of psychological, physical health factors, and quality of life in adult asthma (2019) · cites this paper as [67]
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ResultInfluentialQuirce, S., Plaza, V., Picado, C., Vennera, M. D. C., & Casafont, J. (2011) · PubMed · Cited by 64 · see citing works
Hur, J., Kang, J. Y., Kim, Y. K., Lee, S. Y., & Lee, H. Y. (2021) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2021.102003 · Cited by 63 · see citing works
Prospective Study on the Relationship of Obesity to Asthma Impairment and Risk
Schatz, M. X., Zeiger, R. S., Yang, S.-J., Chen, W., Sajjan, S., Allen‐Ramey, F., & Camargo, C. A. (2015) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2015.03.017 · Cited by 62 · see citing works
Scott, S., Currie, J., Albert, P. S., CALVERLEY, P. M. A., & Wilding, J. P. H. (2011) · CHEST Journal · doi:10.1378/chest.11-0948 · Cited by 61 · see citing works
Obesity and Asthma: Impact on Severity, Asthma Control, and Response to Therapy
Juel, C. T., & Ulrik, C. S. (2013) · Respiratory Care · doi:10.4187/respcare.02202 · Cited by 60 · see citing works
Dixon, A. E., & Que, L. G. (2022) · Seminars in Respiratory and Critical Care Medicine · doi:10.1055/s-0042-1742384 · Cited by 57 · see citing works
Allergic disease is associated with epilepsy in childhood: a US population‐based study
Silverberg, J. I., Joks, R. O., & Durkin, H. G. (2013) · Allergy · doi:10.1111/all.12319 · Cited by 57 · see citing works
Obesity, expiratory flow limitation and asthma symptoms
Mahadev, S., Farah, C. S., King, G. G., & Salome, C. M. (2012) · Pulmonary Pharmacology & Therapeutics · doi:10.1016/j.pupt.2012.05.004 · Cited by 56 · see citing works
Do mast cells link obesity and asthma?
Sismanopoulos, N., Delivanis, D. A., Mavrommati, D., Hatziagelaki, E. E., Conti, P., & Theoharides, T. C. (2012) · Allergy · doi:10.1111/all.12043 · Cited by 54 · see citing works
“Current asthma treatment modalities are not as effective in the obese patient with asthma (15,16,109,110).”
BackgroundDeterminants of Asthma Control in Tertiary Level in Turkey: A Cross-Sectional Multicenter Survey
Türktaş, H., Mungan, D., Uysal, M. A., Oğuzülgen, K., & The Turkish Asthma Control Survey ( Study Group (2010) · Journal of Asthma · doi:10.3109/02770901003692777 · Cited by 54 · see citing works
“Some studies have reported an association between obesity and asthma control (14, 19).”
BackgroundAsthma medication use in obese and healthy weight asthma: systematic review/meta-analysis
Thompson, C. A., Eslick, S., Berthon, B. S., & Wood, L. G. (2020) · European Respiratory Journal · doi:10.1183/13993003.00612-2020 · Cited by 53 · see citing works
Obesity and Poor Asthma Control in Patients with Severe Asthma
Barros, L. L., Souza‐Machado, A., Corrêa, L. B., Santos, J. S., Cruz, C. S., Leite, M. D. S., de Castro, L. A. M., Coelho, A. C. C., Almeida, P. C. A., & Cruz, Á. A. (2011) · Journal of Asthma · doi:10.3109/02770903.2011.554940 · Cited by 53 · see citing works
“(26), demonstrated that patients with higher BMIs had higher scores on the ACQ, independent of age, gender, and asthma severity, which indicates that obesity is associated with a decline in asthma control.”
BackgroundDoes higher body mass index contribute to worse asthma control in an urban population?
Clerisme-Beaty, E. M., Karam, S., Rand, C. S., Patino, C. M., Bilderback, A. L., Riekert, K. A., Okelo, S. O., & Diette, G. B. (2009) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2009.05.034 · Cited by 53 · see citing works
Kim, T., Park, C. S., Bae, Y., Cho, Y. S., & Moon, H. (2009) · Annals of Allergy Asthma & Immunology · doi:10.1016/s1081-1206(10)60530-3 · Cited by 52 · see citing works
Statins as potential therapeutic drug for asthma?
Yuan, C., Zhou, L., Cheng, J., Zhang, J., Teng, Y., Huang, M., Adcock, I. M., Barnes, P. J., & Yao, X. (2012) · Respiratory Research · doi:10.1186/1465-9921-13-108 · Cited by 52 · see citing works
“Finally, studies have demonstrated that obesity was associated with poor asthma control [37,38] and poor response to ICS treatment [39].”
BackgroundControl of asthma in children: still unacceptable? A French cross-sectional study
Jacques de, B. L. I. C., Boucot, I. H., Pribil, C., Robert, J., Huas, D., & Marguet, C. (2009) · Respiratory Medicine · doi:10.1016/j.rmed.2009.03.006 · Cited by 51 · see citing works
Association Between Generalized Anxiety Disorder and Asthma Morbidity
Lavoie, K., Boudreau, M., Plourde, A., Campbell, T. S., & Bacon, S. (2011) · Psychosomatic Medicine · doi:10.1097/psy.0b013e318222e9fc · Cited by 50 · see citing works
Self-citationShore, S. A., Williams, E. S., & Zhu, M. (2008) · Journal of Applied Physiology · doi:10.1152/japplphysiol.00117.2008 · Cited by 49 · see citing works
“Obesity also appears to impact asthma control and the efficacy of certain asthma medications (13, 36, 51, 55).”
BackgroundObesity and Asthma in Children: Current and Future Therapeutic Options
Lang, J. E. (2014) · Pediatric Drugs · doi:10.1007/s40272-014-0069-1 · Cited by 47 · see citing works
“Post-hoc data has shown that obesity is associated with reduced response to inhaled corticosteroids [44, 45, 47, 65–70] and low-dose theophylline [47], and a slightly improved response to montelukast [66].”
Asthma, smoking and BMI in adults with intellectual disabilities: a community‐based survey
Gale, L., Naqvi, H., & Russ, L. (2009) · Journal of Intellectual Disability Research · doi:10.1111/j.1365-2788.2009.01192.x · Cited by 47 · see citing works
Schatz, M. X. (2012) · Current Opinion in Allergy and Clinical Immunology · doi:10.1097/aci.0b013e32835335ac · Cited by 47 · see citing works
“Summary of predictors of asthma impairment or risk identified in the literature Predictor References for predictors Comment Impairment (validated tools) Risk (ED visits or hospitalizations) Not modifiable Increased surveillance Women [10–15] [16] Minorities [17–19] [16,20] Increased disease severity [10,19,21–23] [16,…”
InfluentialReassessing the Evidence Hierarchy in Asthma: Evaluating Comparative Effectiveness
Price, D. B., Chisholm, A., van der Molen, T., Roche, N., Hillyer, E. V., & Bousquet, J. J. (2011) · Current Allergy and Asthma Reports · doi:10.1007/s11882-011-0222-7 · Cited by 46 · see citing works
“nique, current smokers, obese patients, those with comorbid conditions (eg, rhinitis), and those with low adherence to therapy [11–14, 22–28].”
The Relationship of Psychological Factors and Asthma Control to Health-Related Quality of Life
González-Freire, B., Vázquez, I., & Pértega-Díaz, S. (2019) · The Journal of Allergy and Clinical Immunology In Practice · doi:10.1016/j.jaip.2019.07.009 · Cited by 46 · see citing works
Haselkorn, T., Fish, J. E., Chipps, B. E., Miller, D. P., Chen, H., & Weiss, S. T. (2008) · Respiratory Medicine · doi:10.1016/j.rmed.2008.08.010 · Cited by 43 · see citing works
Health-related quality of life in asthma patients - A comparison of two cohorts from 2005 and 2015
Sundh, J., Wireklint, P., Hasselgren, M., Montgomery, S., Ställberg, B., Lisspers, K., & Janson, C. (2017) · Respiratory Medicine · doi:10.1016/j.rmed.2017.10.010 · Cited by 42 · see citing works
Mediator Effect of Depressive Symptoms on the Association Between BMI and Asthma Control in Adults
Boudreau, M., Bacon, S., Ouellet, K., Jacob, A., & Lavoie, K. (2014) · CHEST Journal · doi:10.1378/chest.13-1796 · Cited by 38 · see citing works
Self-citationHigh prevalence of severe asthma in a large random population study
Mincheva, R., Ekerljung, L., Bossios, A., Lundbäck, B., & Lötvall, J. (2018) · Journal of Allergy and Clinical Immunology · doi:10.1016/j.jaci.2017.07.047 · Cited by 37 · see citing works
Obesity and asthma: clinical and laboratory characterization of a common combination
de Jesus, J. P. V., Lima-Matos, A., Almeida, P. C. A., Lima, V. B., de Mello, L. M., Souza‐Machado, A., Ponte, E. V., & Cruz, Á. A. (2018) · Jornal Brasileiro de Pneumologia · doi:10.1590/s1806-37562017000000034 · Cited by 37 · see citing works
“Studies aimed at clarifying the relationship between obesity and asthma have suggested that obesity has effects on respiratory mechanics, alters immune response, and has metabolic implications.(1,3-5) There is evidence that obesity increases the infl ammatory process in the lungs of subjects with asthma.”
BackgroundMcLoughlin, R. F., & McDonald, V. M. (2021) · Frontiers in Allergy · doi:10.3389/falgy.2021.735030 · Cited by 37 · see citing works
“Whether obesity increases asthma severity however remains unclear, with conflicting evidence reported in the literature (42, 49, 51, 52).”
BackgroundObesity and symptoms of depression contribute independently to the poor asthma control of obesity
Kapadia, S., Wei, C. Y., Bartlett, S. J., Lang, J. E., Wise, R. A., & Dixon, A. E. (2014) · Respiratory Medicine · doi:10.1016/j.rmed.2014.05.012 · Cited by 36 · see citing works
Asthma symptom perception and obesity in children
Kopel, S. J., Walders‐Abramson, N., McQuaid, E. L., Seifer, R., Koinis‐Mitchell, D., Klein, R. B., Wamboldt, M. Z., & Fritz, G. K. (2009) · Biological Psychology · doi:10.1016/j.biopsycho.2009.11.007 · Cited by 36 · see citing works
“…actual differences in asthma severity between obese and normal weight individuals with asthma (e.g., Bibi et al., 2004), numerous studies of adults (Lavoie et al., 2006; Schachter et al., 2001; Sin et al., 2002; Thomson et al., 2003) and children (Belamarich et al., 2000; Bibi et al., 2004;…”
Ma, J., Strub, P., Camargo, C. A., Xiao, L., Ayala, E., Gardner, C. D., Buist, A. S., Haskell, W. L., Lavori, P. W., & Wilson, S. R. (2010) · BMC Pulmonary Medicine · doi:10.1186/1471-2466-10-16 · Cited by 35 · see citing works
Noonan, C. W., Brown, B. D., Bentley, B., Conway, K., Corcoran, M., FourStar, K., Freide, P., Hemlock, B., Wagner, S., & Wilson, T. (2010) · Journal of Asthma · doi:10.3109/02770901003759436 · Cited by 34 · see citing works
Stridsman, C., Bäckman, H., Eklund, B., Rönmark, E., & Hedman, L. (2017) · Pediatric Pulmonology · doi:10.1002/ppul.23723 · Cited by 34 · see citing works
Key factors associated with uncontrolled asthma – the Asthma Control in Latin America Study
Neffen, H. E., Marco Chahuán, Y., Hernández, D. D., Vallejo-Perez, E., Bolívar, F., Sánchez, M. H., Galleguillos, F., Castaños, C., Silva, R. S., Giugno, E. R., et al. (2019) · Journal of Asthma · doi:10.1080/02770903.2018.1553050 · Cited by 36 · see citing works
“In the multivariate analysis, obesity was associated with worse disease control, which aligns with other studies in which higher BMI was found to be associated with poor asthma control [6,27,34].”
ResultGrammer, L. C., Weiss, K. B., Pedicano, J. B., Kimmel, L. G., Curtis, L. M., Catrambone, C. D., Lyttle, C. S., Sharp, L. K., & Sadowski, L. S. (2010) · Journal of Asthma · doi:10.3109/02770901003801980 · Cited by 32 · see citing works
Influence of obesity on the prevalence and clinical features of asthma
Boulet, L. (2008) · Clinical and investigative medicine · doi:10.25011/cim.v31i6.4926 · Cited by 32 · see citing works
Prevalence of obesity in asthma and its relations with asthma severity and control
Forte, G. C., Grutcki, D. M., Menegotto, S. M., Pereira, R. P., & Dalcin, P. D. T. R. (2013) · Revista da Associação Médica Brasileira · doi:10.1016/j.ramb.2013.06.015 · Cited by 31 · see citing works
Impact of body mass index on omalizumab response in adults with moderate-to-severe allergic asthma
Geng, B., Dixon, A. E., Ko, J., Janampally, P., Haselkorn, T., Holweg, C. T. J., Casale, T. B., & Jarjour, N. N. (2022) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2022.01.025 · Cited by 31 · see citing works
Metabolic shift favoring C18:0 ceramide accumulation in obese asthma
Choi, Y., Kim, M., Kim, S. J., Yoo, H., Kim, S., & Park, H. (2020) · Allergy · doi:10.1111/all.14366 · Cited by 30 · see citing works
Association between patterns of leisure time physical activity and asthma control in adult patients
Bacon, S., Lemière, C., Moullec, G., Ninot, G., Pepin, V., & Lavoie, K. (2015) · BMJ Open Respiratory Research · doi:10.1136/bmjresp-2015-000083 · Cited by 29 · see citing works
Self-citationSignificant predictors of poor quality of life in older asthmatics
Kannan, J. A., Bernstein, D. I., Bernstein, C. K., Ryan, P., Bernstein, J. A., Villareal, M. S., Smith, A. M., Lenz, P. H., & Epstein, T. G. (2015) · Annals of Allergy Asthma & Immunology · doi:10.1016/j.anai.2015.06.021 · Cited by 28 · see citing works
Lombardi, C., Gargioni, S., Gardinazzi, A., Canonica, G. W., & Passalacqua, G. (2011) · Journal of Asthma · doi:10.3109/02770903.2011.587581 · Cited by 28 · see citing works
Diet effects in the asthma treatment: A systematic review
Forte, G. C., da Silva, D. T. R., Hennemann, M. L. T., Sarmento, R. A., de Almeida, J. C., & Dalcin, P. D. T. R. (2017) · Critical Reviews in Food Science and Nutrition · doi:10.1080/10408398.2017.1289893 · Cited by 28 · see citing works
“© 2018 Taylor & Francis Group, LLC potential antioxidant effects tend to increase the prevalence of the disease and lead to deterioration of symptoms (Devereux and Seaton, 2005; Lavoie et al., 2006).”
BackgroundRoche, N., Plaza, V., Backer, V., van der Palen, J. A. M., Cerveri, I., Gonzalez, C., SAFIOTI, G. G., Scheepstra, I., Patino, O., & Singh, D. (2020) · npj Primary Care Respiratory Medicine · doi:10.1038/s41533-019-0159-1 · Cited by 27 · see citing works
Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician
Andrenacci, B., Ferrante, G., Roberto, G., PIACENTINI, G. L., Grutta, S. L., Marseglia, G. L., & Licari, A. (2022) · Expert Review of Clinical Immunology · doi:10.1080/1744666x.2022.2093187 · Cited by 27 · see citing works
Health-related quality of life in childhood bronchial asthma
Al, M. S., El-Hosseiny, M., Elezz, N. F. A., El, D. H., & Hassan, A. M. (2013) · Cited by 27 · see citing works
Fitzgerald, M. P., Hennigan, K., O’Gorman, C. S., & McCarron, L. C. (2018) · Irish Journal of Medical Science (1971 -) · doi:10.1007/s11845-018-1814-1 · Cited by 27 · see citing works
Validation of the asthma impact survey, a brief asthma-specific quality of life tool
Schatz, M. N., Mosen, D. M., Kosinski, M. R., Vollmer, W. M., O’Connor, E., Cook, E. F., & Zeiger, R. S. (2006) · Quality of Life Research · doi:10.1007/s11136-006-9103-2 · Cited by 27 · see citing works
“Independent predictors of AIS-6 and AQLQ scores Oral corticosteroid use, a history of COPD, BMI, female sex, lower education, and a history of an asthma hospitalization in the past year were significant independent predictors of both the AIS-6 and AQLQ in this sample (Table 10).”
BackgroundInfluentialDragomir, A. I., Boucher, V., Bacon, S., Gemme, C., Szczepanik, G., Corace, K., Campbell, T., Vallis, M., Garber, G., Rouleau, C., et al. (2020) · Translational Behavioral Medicine · doi:10.1093/tbm/ibaa015 · Cited by 21 · see citing works
Self-citationAssociation of obesity with asthma severity, control and quality of life.
Maâlej, S., Yacoub, Z., Fakhfekh, R., Yaalaoui, S., Kheder, A. B., & Drira, I. (2012) · Europe PMC (PubMed Central) · Cited by 26 · see citing works
The treatment of asthma in obesity
Dixon, A. E. (2012) · Expert Review of Respiratory Medicine · doi:10.1586/ers.12.22 · Cited by 25 · see citing works
Weight loss interventions for chronic asthma
Adeniyi, F. B., & Young, T. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009339 · Cited by 25 · see citing works
Asthma in obese women: outcomes and factors involved.
Kilic, H., Oğuzülgen, I. K., Bakir, F., & Türktaş, H. (2011) · PubMed · Cited by 24 · see citing works
Immunometabolism in Obese Asthmatics: Are We There Yet?
Periyalil, H., Gibson, P. G., & Wood, L. G. (2013) · Nutrients · doi:10.3390/nu5093506 · Cited by 24 · see citing works
“and quality of life [9,176,189].”
Role of metalloproteinases and TNF-α in obesity-associated asthma in mice
Vieira, C. P., de Oliveira, L. P., da Silva, M. B., André, D. M., Tavares, E. B. G., Pimentel, E. R., & Antunes, E. (2020) · Life Sciences · doi:10.1016/j.lfs.2020.118191 · Cited by 23 · see citing works
Holguín, F., Rojas, M., & Hart, C. M. (2007) · Lung · doi:10.1007/s00408-007-9035-9 · Cited by 23 · see citing works
“In addition, conventional asthma therapy may not be as efficacious in obese as in nonobese asthmatics [5].”
BackgroundValidity and Reliability Evidence of the Asthma Control Test – Act in Greece
Grammatopoulou, E. P., Stavrou, N. A. M., Myrianthefs, P. M., Karteroliotis, K. E., Baltopoulos, G. J., BEHRAKIS, P. K., & Koutsouki, D. (2010) · Journal of Asthma · doi:10.3109/02770903.2010.529222 · Cited by 22 · see citing works
“As regards BMI, Greek patients with normal BMI had better asthma control compared to the overweight/obese, which is in accordance with previous studies (38, 47, 48).”
ResultPrevalence and Features of Asthma in Young Adults in Urban Areas of Argentina
Arias, S., Neffen, H. E., Bossio, J. C., Calabrese, C. A., Videla, A. J., Armando, G., & Antó, J. M. (2018) · Archivos de Bronconeumología · doi:10.1016/j.arbr.2018.01.014 · Cited by 22 · see citing works
“Excel 2013 and IBM SPSS Statistics 21 were used for the preparation of tables and statistical analysis.”
- Authors
- Lavoie, K. L., Bacon, S. L., Labrecque, M., Cartier, A., & Ditto, B.
- Affiliations
- Université du Québec à Montréal (CA)
- Hôpital du Sacré-Cœur de Montréal (CA)
- McGill University (CA)
- Corresponding author
- Lavoie, Kim L.
- Venue
- Respiratory Medicine
- Publisher
- Elsevier BV
- Published
- 2006-04
- Volume
- 100
- Issue
- 4
- Pages
- 648-657
- ISSN
- 0954-6111 (ISSN-L)
- OpenAlex
- W2058669590
- Cited by
- 243
- References
- 50
- Citations by year
- 2026: 4 · 2025: 8 · 2024: 7 · 2023: 8 · 2022: 9 · 2021: 8 · 2020: 12 · 2019: 8 · 2018: 12 · 2017: 13 · 2016: 8 · 2015: 11 · 2014: 20 · 2013: 19 · 2012: 21
- FWCI
- 6.02
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Respiratory Medicine (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
- Keywords
- asthma, obesity, body mass index, asthma control, asthma quality of life, asthma severity, overweight, Asthma Control Questionnaire, Asthma Quality of Life Questionnaire
- MeSH terms
- Adult, Aged, Asthma, Bronchodilator Agents, Canada, Cross-Sectional Studies, Female, Forced Expiratory Volume, Humans, Male, Middle Aged, Obesity, Quality of Life, Surveys and Questionnaires, Severity of Illness Index, Comorbidity, Body Mass Index
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