Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma?

William J. Anderson, Brian J. Lipworth

    Research output: Contribution to journalArticle

    26 Citations (Scopus)

    Abstract

    Background: Although the relationship between asthma and obesity has been extensively explored, the effect of body mass index (BMI) on the dose-response relationship to inhaled corticosteroids (ICS) has received little attention.

    Objective: To assess the dose-response of inhaled budesonide on outcome measures of asthma between overweight and normal weight patients with persistent asthma.

    Methods: Seventy-two patients with mild to moderate persistent asthma from a post hoc analysis of previously reported trial data were divided into 2 groups: overweight, BMI 25 kg/m(2) or higher; normal weight, BMI less than 25 kg/m(2). Each group received 4 weeks' treatment with inhaled (hydrofluoroalkane) budesonide 200 mu g/day then 800 mu g/day with ICS washout pretreatment. Outcome measures forced expiratory volume in 1 second (FEV1), fractional exhaled nitric oxide (FeNO), methacholine PC20, total daily asthma symptom score, and overnight urinary cortisol/creatinine ratio were performed at baseline and after each dose.

    Results: Significantly greater improvements were seen in the normal weight group for both FeNO and symptom responses at 0 to 200 mu g and 0 to 800 mu g ICS doses (as change from baseline), compared with the overweight group: FeNO 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .045; symptoms 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .013. A trend also was seen toward attenuated cortisol suppression in overweight subjects at 0 to 800 mu g (P = .06), but no significant difference was seen at either dose in FEV1 and methacholine PC20 between weight groups.

    Conclusion: Overweight patients with persistent asthma may have attenuated symptom and FeNO dose responses to inhaled budesonide compared with normal weight patients with asthma, with no differences in FEV1 or methacholine PC20 between groups. Attenuated cortisol suppression in the overweight group may be the clue to this difference, alluding to reduced peripheral lung deposition or absorption in overweight patients with asthma. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

    Original languageEnglish
    Pages (from-to)237-242
    Number of pages6
    JournalAnnals of Allergy, Asthma & Immunology
    Volume108
    Issue number4
    DOIs
    Publication statusPublished - Apr 2012

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    Adrenal Cortex Hormones
    Body Mass Index
    Asthma
    Budesonide
    Methacholine Chloride
    Forced Expiratory Volume
    Nitric Oxide
    Weights and Measures
    Hydrocortisone
    HFA 134a
    Outcome Assessment (Health Care)
    Allergy and Immunology
    Creatinine
    Hypersensitivity
    Obesity
    Lung

    Cite this

    @article{5679add0000040308fb35145dcb84777,
    title = "Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma?",
    abstract = "Background: Although the relationship between asthma and obesity has been extensively explored, the effect of body mass index (BMI) on the dose-response relationship to inhaled corticosteroids (ICS) has received little attention.Objective: To assess the dose-response of inhaled budesonide on outcome measures of asthma between overweight and normal weight patients with persistent asthma.Methods: Seventy-two patients with mild to moderate persistent asthma from a post hoc analysis of previously reported trial data were divided into 2 groups: overweight, BMI 25 kg/m(2) or higher; normal weight, BMI less than 25 kg/m(2). Each group received 4 weeks' treatment with inhaled (hydrofluoroalkane) budesonide 200 mu g/day then 800 mu g/day with ICS washout pretreatment. Outcome measures forced expiratory volume in 1 second (FEV1), fractional exhaled nitric oxide (FeNO), methacholine PC20, total daily asthma symptom score, and overnight urinary cortisol/creatinine ratio were performed at baseline and after each dose.Results: Significantly greater improvements were seen in the normal weight group for both FeNO and symptom responses at 0 to 200 mu g and 0 to 800 mu g ICS doses (as change from baseline), compared with the overweight group: FeNO 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .045; symptoms 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .013. A trend also was seen toward attenuated cortisol suppression in overweight subjects at 0 to 800 mu g (P = .06), but no significant difference was seen at either dose in FEV1 and methacholine PC20 between weight groups.Conclusion: Overweight patients with persistent asthma may have attenuated symptom and FeNO dose responses to inhaled budesonide compared with normal weight patients with asthma, with no differences in FEV1 or methacholine PC20 between groups. Attenuated cortisol suppression in the overweight group may be the clue to this difference, alluding to reduced peripheral lung deposition or absorption in overweight patients with asthma. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.",
    author = "Anderson, {William J.} and Lipworth, {Brian J.}",
    year = "2012",
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    doi = "10.1016/j.anai.2011.12.006",
    language = "English",
    volume = "108",
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    Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma? / Anderson, William J.; Lipworth, Brian J.

    In: Annals of Allergy, Asthma & Immunology, Vol. 108, No. 4, 04.2012, p. 237-242.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Does body mass index influence responsiveness to inhaled corticosteroids in persistent asthma?

    AU - Anderson, William J.

    AU - Lipworth, Brian J.

    PY - 2012/4

    Y1 - 2012/4

    N2 - Background: Although the relationship between asthma and obesity has been extensively explored, the effect of body mass index (BMI) on the dose-response relationship to inhaled corticosteroids (ICS) has received little attention.Objective: To assess the dose-response of inhaled budesonide on outcome measures of asthma between overweight and normal weight patients with persistent asthma.Methods: Seventy-two patients with mild to moderate persistent asthma from a post hoc analysis of previously reported trial data were divided into 2 groups: overweight, BMI 25 kg/m(2) or higher; normal weight, BMI less than 25 kg/m(2). Each group received 4 weeks' treatment with inhaled (hydrofluoroalkane) budesonide 200 mu g/day then 800 mu g/day with ICS washout pretreatment. Outcome measures forced expiratory volume in 1 second (FEV1), fractional exhaled nitric oxide (FeNO), methacholine PC20, total daily asthma symptom score, and overnight urinary cortisol/creatinine ratio were performed at baseline and after each dose.Results: Significantly greater improvements were seen in the normal weight group for both FeNO and symptom responses at 0 to 200 mu g and 0 to 800 mu g ICS doses (as change from baseline), compared with the overweight group: FeNO 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .045; symptoms 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .013. A trend also was seen toward attenuated cortisol suppression in overweight subjects at 0 to 800 mu g (P = .06), but no significant difference was seen at either dose in FEV1 and methacholine PC20 between weight groups.Conclusion: Overweight patients with persistent asthma may have attenuated symptom and FeNO dose responses to inhaled budesonide compared with normal weight patients with asthma, with no differences in FEV1 or methacholine PC20 between groups. Attenuated cortisol suppression in the overweight group may be the clue to this difference, alluding to reduced peripheral lung deposition or absorption in overweight patients with asthma. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

    AB - Background: Although the relationship between asthma and obesity has been extensively explored, the effect of body mass index (BMI) on the dose-response relationship to inhaled corticosteroids (ICS) has received little attention.Objective: To assess the dose-response of inhaled budesonide on outcome measures of asthma between overweight and normal weight patients with persistent asthma.Methods: Seventy-two patients with mild to moderate persistent asthma from a post hoc analysis of previously reported trial data were divided into 2 groups: overweight, BMI 25 kg/m(2) or higher; normal weight, BMI less than 25 kg/m(2). Each group received 4 weeks' treatment with inhaled (hydrofluoroalkane) budesonide 200 mu g/day then 800 mu g/day with ICS washout pretreatment. Outcome measures forced expiratory volume in 1 second (FEV1), fractional exhaled nitric oxide (FeNO), methacholine PC20, total daily asthma symptom score, and overnight urinary cortisol/creatinine ratio were performed at baseline and after each dose.Results: Significantly greater improvements were seen in the normal weight group for both FeNO and symptom responses at 0 to 200 mu g and 0 to 800 mu g ICS doses (as change from baseline), compared with the overweight group: FeNO 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .045; symptoms 0 to 200 mu g, P = .002; 0 to 800 mu g, P = .013. A trend also was seen toward attenuated cortisol suppression in overweight subjects at 0 to 800 mu g (P = .06), but no significant difference was seen at either dose in FEV1 and methacholine PC20 between weight groups.Conclusion: Overweight patients with persistent asthma may have attenuated symptom and FeNO dose responses to inhaled budesonide compared with normal weight patients with asthma, with no differences in FEV1 or methacholine PC20 between groups. Attenuated cortisol suppression in the overweight group may be the clue to this difference, alluding to reduced peripheral lung deposition or absorption in overweight patients with asthma. (C) 2012 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

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    DO - 10.1016/j.anai.2011.12.006

    M3 - Article

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    VL - 108

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    EP - 242

    JO - Annals of Allergy, Asthma & Immunology

    JF - Annals of Allergy, Asthma & Immunology

    SN - 1081-1206

    IS - 4

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