title: Effect of increased body mass index on asthma risk, impairment and response to asthma controller therapy in African Americans.
abstract: OBJECTIVE
  To explore whether obesity alters the risk, impairment and response to treatment in African Americans with asthma.
  
  
  METHODS
  The data used for this secondary analysis are from a 1-year study in African American subjects comparing fluticasone propionate/salmeterol 100/50 microg combination (FSC) and fluticasone propionate 100 microg (FP). Subjects were retrospectively stratified by body mass index (BMI) <20 [underweight], 20-24.9 [normal weight], 25-29.9 [overweight], 30-34.9 [obese I], 35-39.9 [obese II], and >or=40 [obese III] kg/m(2). Outcomes studied included impairment domains: FEV(1), morning and evening peak expiratory flow (AM and PM PEF), daily albuterol use, daily symptom scores and future risk domain: exacerbations.
  
  
  BACKGROUND
  www.clinicaltrials.gov; NCT00102765.
  
  
  RESULTS
  There were 475 subjects evenly distributed between FSC and FP by baseline parameters. There were 207 subjects with a BMI >or=30, including 70 subjects with a BMI >or=40. Baseline BMI >or=40 was associated with numerically lower baseline AM and PM PEF. There was an attenuation of response to both treatments for only PM PEF (p < 0.05). By contrast, subjects with lower degrees of obesity or overweight did not differ from those with normal weight. The total population exacerbation rate was 2-fold greater in obese III subjects (39%) compared with subjects in other BMI categories (16-21%) (p < 0.05). A potential study limitation is the retrospective analysis of existing data.
  
  
  CONCLUSIONS
  Response to treatment was attenuated for PM PEF for subjects with BMI >or=40 and was also associated with an increased rate of asthma exacerbations.
authors.affiliation: Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Camargo
authors.forename: E Rand
authors.initials: ER
authors.lastname: Sutherland
authors.forename: William
authors.initials: W
authors.lastname: Bailey
authors.forename: Mario
authors.initials: M
authors.lastname: Castro
authors.forename: Steven W
authors.initials: SW
authors.lastname: Yancey
authors.forename: Amanda H
authors.initials: AH
authors.lastname: Emmett
authors.forename: David A
authors.initials: DA
authors.lastname: Stempel
mesh_terms: D000293:Adolescent; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology / Q000209:etiology*; D015992:Body Mass Index; D002648:Child; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D016032:Randomized Controlled Trials as Topic; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents