title: Obesity and COPD: associated symptoms, health-related quality of life, and medication use.
abstract: BACKGROUND
  There is little data about the combined effects of COPD and obesity. We compared dyspnea, health-related quality of life (HRQoL), exacerbations, and inhaled medication use among patients who are overweight and obese to those of normal weight with COPD.
  
  
  METHODS
  We performed secondary data analysis on 364 Veterans with COPD. We categorized subjects by body mass index (BMI). We assessed dyspnea using the Medical Research Council (MRC) dyspnea scale and HRQoL using the St. George's Respiratory Questionnaire. We identified treatment for an exacerbation and inhaled medication use in the past year. We used multiple logistic and linear regression models as appropriate, with adjustment for age, COPD severity, smoking status, and co-morbidities.
  
  
  RESULTS
  The majority of our population was male (n = 355, 98%) and either overweight (n = 115, 32%) or obese (n = 138, 38%). Obese and overweight subjects had better lung function (obese: mean FEV(1) 55.4% ±19.9% predicted, overweight: mean FEV(1) 50.0% ±20.4% predicted) than normal weight subjects (mean FEV(1) 44.2% ±19.4% predicted), yet obese subjects reported increased dyspnea [adjusted OR of MRC score ≥2 = 4.91 (95% CI 1.80, 13.39], poorer HRQoL, and were prescribed more inhaled medications than normal weight subjects. There was no difference in any outcome between overweight and normal weight patients.
  
  
  CONCLUSIONS
  Despite having less severe lung disease, obese patients reported increased dyspnea and poorer HRQoL than normal weight patients. The greater number of inhaled medications prescribed for obese patients may represent overuse. Obese patients with COPD likely need alternative strategies for symptom control in addition to those currently recommended.
authors.affiliation: Health Services Research and Development, Department of Veterans Affairs Puget Sound Health Care System, Seattle, WA, USA. lcecere@u.washington.edu
authors.forename: Laura M
authors.initials: LM
authors.lastname: Cecere
authors.forename: Alyson J
authors.initials: AJ
authors.lastname: Littman
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Slatore
authors.forename: Edmunds M
authors.initials: EM
authors.lastname: Udris
authors.forename: Chris L
authors.initials: CL
authors.lastname: Bryson
authors.forename: Edward J
authors.initials: EJ
authors.lastname: Boyko
authors.forename: David J
authors.initials: DJ
authors.lastname: Pierson
authors.forename: David H
authors.initials: DH
authors.lastname: Au
mesh_terms: D000280:Administration, Inhalation; D000368:Aged; D015992:Body Mass Index; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D003430:Cross-Sectional Studies; D004417:Dyspnea / Q000503:physiopathology; D005260:Female; D006787:Hospitals, Veterans; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications / Q000503:physiopathology*; D010817:Physician-Patient Relations; D029424:Pulmonary Disease, Chronic Obstructive / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology*; D011788:Quality of Life; D012044:Regression Analysis; D012129:Respiratory Function Tests; D012907:Smoking / Q000009:adverse effects / Q000503:physiopathology; D011795:Surveys and Questionnaires; D014861:Washington
chemical_list: D001993:Bronchodilator Agents