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      Obesity and respiratory diseases

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          Abstract

          The obesity epidemic is a global problem, which is set to increase over time. However, the effects of obesity on the respiratory system are often underappreciated. In this review, we will discuss the mechanical effects of obesity on lung physiology and the function of adipose tissue as an endocrine organ producing systemic inflammation and effecting central respiratory control. Obesity plays a key role in the development of obstructive sleep apnea and obesity hypoventilation syndrome. Asthma is more common and often harder to treat in the obese population, and in this study, we review the effects of obesity on airway inflammation and respiratory mechanics. We also discuss the compounding effects of obesity on chronic obstructive pulmonary disease (COPD) and the paradoxical interaction of body mass index and COPD severity. Many practical challenges exist in caring for obese patients, and we highlight the complications faced by patients undergoing surgical procedures, especially given the increased use of bariatric surgery. Ultimately, a greater understanding of the effects of obesity on the respiratory disease and the provision of adequate health care resources is vital in order to care for this increasingly important patient population.

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          Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies.

          David Beuther, E Sutherland (2007)
          Although obesity has been implicated as an asthma risk factor, there is heterogeneity in the published literature regarding its role in asthma incidence, particularly in men. To quantify the relationship between categories of body mass index (BMI) and incident asthma in adults and to evaluate the impact of sex on this relationship. Online bibliographic databases were searched for prospective studies evaluating BMI and incident asthma in adults. Independent observers extracted data regarding annualized asthma incidence from studies meeting predetermined criteria, within defined categories of normal weight (BMI or= 30). Data were analyzed by inverse-variance-weighted, random-effects meta-analysis. Stratified analysis between BMI categories and within sex was performed. Seven studies (n=333,102 subjects) met inclusion criteria. Compared with normal weight, overweight and obesity (BMI >or= 25) conferred increased odds of incident asthma, with an odds ratio (OR) of 1.51 (95% confidence interval [CI], 1.27-1.80). A dose-response effect of elevated BMI on asthma incidence was observed; the OR for incident asthma for normal-weight versus overweight subjects was 1.38 (95% CI, 1.17-1.62) and was further elevated for normal weight versus obesity (OR, 1.92; 95% CI, 1.43-2.59; p<0.0001 for the trend). A similar increase in the OR of incident asthma due to overweight and obesity was observed in men (OR, 1.46; 95% CI, 1.05-2.02) and women (OR, 1.68; 95% CI, 1.45-1.94; p=0.232 for the comparison). Overweight and obesity are associated with a dose-dependent increase in the odds of incident asthma in men and women, suggesting asthma incidence could be reduced by interventions targeting overweight and obesity.
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            Excess weight and sleep-disordered breathing.

            Terry Young, Paul Peppard, Shahrad Taheri (2005)
            Excess weight is a well-established predictor of sleep-disordered breathing (SDB). Clinical observations and population studies throughout the United States, Europe, Asia, and Australia have consistently shown a graded increase in the prevalence of SDB as body mass index, neck girth, or other measures of body habitus increases. Clinical studies of weight loss and longitudinal population studies provide strong support for a causal association. The role of excess body weight, a modifiable risk factor, with SDB raises many questions relevant to clinical practice and public health. The topic takes on added importance with the alarming rate of weight gain in children as well as adults in industrialized nations. Among adults ages 30-69 yr, averaging over the estimated United States 2003 age, sex, and BMI distributions, we estimate that approximately 17% of adults have mild or worse SDB (apnea-hypopnea index > or = 5) and that 41% of those adults have SDB "attributable" to having a body mass index of > or =25 kg/m(2). Similarly, we estimate that approximately 5.7% of adults have moderate or worse SDB (apnea-hypopnea index > or = 15) and that 58% of those adults have SDB attributable to excess weight. Clearly, if the expanding epidemic of obesity seen in the United States continues, the prevalence of SDB will almost certainly increase, along with the proportion of SDB attributable to obesity.
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              Prediction of difficult mask ventilation.

              C Huraux, P Coriat, Dario Bianchi … (2000)
              Maintenance of airway patency and oxygenation are the main objectives of face-mask ventilation. Because the incidence of difficult mask ventilation (DMV) and the factors associated with it are not well known, we undertook this prospective study. Difficult mask ventilation was defined as the inability of an unassisted anesthesiologist to maintain the measured oxygen saturation as measured by pulse oximetry > 92% or to prevent or reverse signs of inadequate ventilation during positive-pressure mask ventilation under general anesthesia. A univariate analysis was performed to identify potential factors predicting DMV, followed by a multivariate analysis, and odds ratio and 95% confidence interval were calculated. A total of 1,502 patients were prospectively included. DMV was reported in 75 patients (5%; 95% confidence interval, 3.9-6.1%), with one case of impossible ventilation. DMV was anticipated by the anesthesiologist in only 13 patients (17% of the DMV cases). Body mass index, age, macroglossia, beard, lack of teeth, history of snoring, increased Mallampati grade, and lower thyromental distance were identified in the univariate analysis as potential DMV risk factors. Using a multivariate analysis, five criteria were recognized as independent factors for a DMV (age older than 55 yr, body mass index > 26 kg/m2, beard, lack of teeth, history of snoring), the presence of two indicating high likelihood of DMV (sensitivity, 0.72; specificity, 0.73). In a general adult population, DMV was reported in 5% of the patients. A simple DMV risk score was established. Being able to more accurately predict DMV may improve the safety of airway management.
              Article 0 comments Cited 125 times – based on 0 reviews     Review now
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                Author and article information

                Journal
                Journal ID (nlm-ta): Int J Gen Med
                Title: International Journal of General Medicine
                Publisher: Dove Medical Press
                ISSN (Electronic): 1178-7074
                Publication date Collection: 2010
                Publication date (Electronic): 20 October 2010
                Volume: 3
                Pages: 335-343
                Affiliations
                Sleep and Ventilation Unit, Department of Respiratory Medicine, North Middlesex University Hospital, London, UK
                Author notes
                Correspondence: Himender K Makker, Sleep and Ventilation Unit, Chest Clinic, North Middlesex University Hospital, Sterling Way, London N18 1QX, UK, Email himender.makker@ 123456nmh.nhs.uk
                Article
                Publisher ID: ijgm-3-335
                DOI: 10.2147/IJGM.S11926
                PMC ID: 2990395
                PubMed ID: 21116339
                SO-VID: 67dd8243-bcc4-43d2-9b91-b8ce52c8d791
                Copyright © © 2010 Zammit et al, publisher and licensee Dove Medical Press Ltd.
                License:

                This is an Open Access article which permits unrestricted noncommercial use, provided the original work is properly cited.

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                Categories
                Subject: Review

                ScienceOpen disciplines: Medicine
                Keywords: anesthesia,obstructive sleep apnea,obesity,obesity hypoventilation syndrome,lung function
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: anesthesia, obstructive sleep apnea, obesity, obesity hypoventilation syndrome, lung function

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