Asthma severity is associated with body mass index and early menarche in women.
ABSTRACT Asthma severity in relation to body mass index (BMI) has rarely been studied. The relation between BMI and asthma severity was studied by sex in 366 adults with asthma from the Epidemiological Study on the Genetics and Environment of Asthma, a case-control and family study on asthma. Factors related to asthma severity and BMI such as smoking, FEV(1), bronchial hyperresponsiveness, and dyspnea were taken into account. The influence of early menarche was studied to assess the potential role of hormonal factors. Clinical asthma severity in the last 12 months was assessed by a score (0-7) based on the frequency of asthma attacks, persisting symptoms between attacks, and hospitalization. Asthma severity, which was unrelated to sex, increased with BMI in women (p = 0.0001) but not in men (p = 0.3). In women, the association remained after adjustment for age, FEV(1), smoking habits, and BMI-adjusted dyspnea and taking into account familial dependence (p = 0.0001). The association between BMI and severity was stronger in women with early menarche than in women without early menarche (p interaction = 0.02). Findings support the hypothesis of hormonal factors involved in the severity of asthma.
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ABSTRACT: RESUMEN Antecedentes: la obesidad es considerada una epidemia en varios países. En México se ha relacionado con diversas enfermedades, especialmente con el asma. La relación entre asma y obesidad se explica por un factor mecánico restrictivo de la grasa sobre la pared torácica, aumento del volumen sanguíneo pulmonar y mayor intensidad de los síntomas. Objetivo: determinar la relación entre el índice de masa corporal y la severidad del asma en los pacientes adultos alérgicos. Métodos: se evaluaron 121 pacientes, en quienes se realizó el diagnóstico y clasificación de la severidad del asma, según los criterios de la GINA (2004). Los resultados se analizaron con estadística descriptiva. Resultados: se registraron 86 (71.07%) mujeres y 35 (28.92%) hombres, cuyo promedio de edad fue de 30.9 años. El peso promedio fue de 70.15 kg (42-111.5 kg), la talla de 1.60 m (1.41-1.85 m), el IMC de 27.35 kg/m 2 (17.25 a 41.37 kg/m 2). De acuerdo con la severidad del asma: 24 pacientes tuvieron asma leve intermitente; 35, leve persistente; 45, moderada persistente, y 17 con severa persistente. Conclusiones: es evidente la relación entre el índice de masa corporal y la severidad del asma, pues los pacientes con IMC mayor de 25 kg/m 2 son más susceptibles a padecer asma en grado moderado a severo, principalmente las mujeres. Palabras clave: asma, severidad, índice de masa corporal.
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ABSTRACT: The objective of this study is to determine the prevalence of asthma symptoms and overweight-obese in children aged 6-7years and adolescents aged 13-14 years within the metropolitan area of Pamplona, and analyse the risk of asthma within the age groups and the influences if sex on this relationship.Nutricion hospitalaria. 01/2014; 30(n03):519-525.
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ABSTRACT: Observations of increasing asthma incidence, decreasing age at menarche, and common risk factors have led investigators to hypothesize potential associations of age at menarche or menstrual characteristics with incidence of adult onset asthma. We evaluated these associations among reproductive age women.Reproductive system & sexual disorders : current research. 08/2012; 1(3).
Asthma severity is associated with body mass index and early menarche in women
Raphaëlle Varraso1*, PhD student
Valérie Siroux1,2, PhD
Jean Maccario1, PhD
Isabelle Pin2, MD
Francine Kauffmann1, MD
on behalf of the Epidemiological study on the Genetics and Environment of Asthma (EGEA)
1 INSERM U472-IFR 69, Epidemiology and biostatistics, Villejuif, France
2 Grenoble CHU, Grenoble, France
* Corresponding author:
16 avenue Paul Vaillant Couturier, 94807 Villejuif cedex, France
Telephone (33) 1 45 59 52 61; Fax (33) 1 45 59 51 69
Running title: Body mass index and asthma severity
Subject category list: 57
Word count: 3176
This article has an online data supplement, which is accessible from this issue’s table of
content online at www.atsjournal.org
AJRCCM Articles in Press. Published on November 19, 2004 as doi:10.1164/rccm.200405-674OC
Copyright (C) 2004 by the American Thoracic Society.
Asthma severity in relation to body mass index (BMI) has rarely been studied. The relation
between BMI and asthma severity was studied by sex in 366 adult asthmatics from the
Epidemiological study on the Genetics and Environment of Asthma, (EGEA), a case control
and family study on asthma. Factors related to asthma severity and BMI such as smoking,
FEV1, bronchial hyperresponsiveness (BHR) and dyspnea were taken into account. The
influence of early menarche was studied to assess the potential role of hormonal factors.
Clinical asthma severity in the last 12 months was assessed by a score (0-7), based on the
frequency of asthma attacks, persisting symptoms between attacks and hospitalization.
Asthma severity which was unrelated to gender, increased with BMI in women (p=0.0001),
but not in men (p=0.3). In women, the association remained after adjustment on age, FEV1,
smoking habits, BMI-adjusted dyspnea and taking into account familial dependence
(p=0.0001). The association between BMI and severity was stronger in women with early
menarche than in women without early menarche (p interaction = 0.02). Findings support the
hypothesis of hormonal factors involved in the severity of asthma.
Abstract word count: 185
Keywords: asthma severity, body mass index, gender, menarche.
In the last decades a significant and a concomitant increase in the prevalence of both
asthma and obesity occurred worldwide. Association of asthma incidence with body mass
index (BMI) and weight gain has been reported in women (1-4) but not in men in most studies
(2, 4), but not in all (5, 6, 7). Decrease in physical activity due to asthma does not seem to
explain the association (2). It is well known that asthma incidence is greater in boys than in
girls (8, 9). With the onset of puberty, asthma incidence and frequency of hospital admissions
for asthma are higher among women compared with men and remain higher throughout the
reproductive years (10). Gender differences may depend of hormonal factors (sex-related) as
well as gender-related behaviors (11-13). Early onset of puberty and obesity independently
favor the persistence of asthma (14).
Women have more severe asthma than men (15), report more dyspnea (8) and have
more bronchial hyperresponsiveness (BHR) (16), associations only partly understood. Obesity
may directly affect the asthma phenotype by mechanical effects including airways latching
and increasing in airways resistance and responsiveness to methacholine (17). It is known that
the perception of airflow limitation is different according to sex and it has been suggested that
obesity could be more related to dyspnea than to airflow limitation (18). Therefore, sex-
related patterns of asthma may depend on interrelationships of BMI, lung function, BHR and
dyspnea. Factors related to asthma severity may be similar or different from those related to
asthma incidence. Only one study reported an association of BMI with asthma severity in
women, but not in men (19). Until now, no epidemiological study has included hormones
levels (leptin and sexual hormones) to establish their role in sex-related patterns of asthma
and related phenotypes. The cumulative frequency of ovulatory menstrual cycles is a critical
determinant of a hormone-dependent disease, such as breast cancer (20), and results on breast
cancer provide a research frame regarding the role of hormone-related events for asthma.
The purpose of the study was to determine the relation between BMI and severity of
asthma by sex, taking into account factors related to asthma severity and BMI such as
smoking, FEV1, BHR or dyspnea and to investigate the potential role of hormonal factors, by
studying early menarche. Some of the results have been previously reported in the form of an
The design of EGEA combines a case-control study and a family study of asthmatic
cases. The protocol and descriptive characteristics have been described elsewhere (22-25, see
online supplement). Out of the 368 subjects without missing data on BMI and FEV1, 2
outliers with morbid obesity were excluded (see online data supplement). The analysis was
performed on 366 adult (≥ 16 years) asthmatics (211 cases and 155 relatives of cases).
Subjects answered a questionnaire regarding respiratory symptoms, environment and
treatment (including inhaled and oral steroids) based on international standardized
questionnaires (25). For relatives, asthma status was based on a positive answer to either
"Have you ever had attacks of breathlessness at rest with wheezing?" or "Have you ever had
asthma attacks?". Dyspnea was evaluated according to 5-point grading scale. For all
asthmatics, the severity was assessed based on international guidelines (26), similarly as in
the study of the familial resemblance of asthma severity (27). Three criteria of severity were
assessed (see Table E1): the clinical asthma severity score in the last 12 months,
hospitalization for asthma during life and the use of inhaled steroids in the last 12 months.
The clinical score was the primary outcome and was evaluated as a continuous variable. It
varied between 0 and 7 and was based on frequency of asthma attacks (from 0 for less than
once a month to 3 for at least once a day), persisting symptoms between attacks (from 0 for
none to 3 for limiting activities) and hospitalization in the past 12 months (0 for none, 1 for
more than 0).
A three-class BHR score was defined corresponding to the cumulative dose of
methacholine producing a decline of 20% or more in FEV1: none (dose > 4 mg), mild (0.25
mg < dose ≤ 4 mg) and severe (dose ≤ 0.25 mg). The analysis using BHR did not include 184