Overweight in patients with chronic obstructive pulmonary disease needs more attention: a cross-sectional study in general practice

Lisa D M Verberne,Ilse C S Swinkels,Christel E Van Dijk,Dinny H De Bakker,Mark M J Nielen,Chantal J Leemrijse

doi:10.1038/s41533-017-0065-3

Lisa D M Verberne, Ilse C S Swinkels + Show 4 more

Open Access

https://doi.org/10.1038/s41533-017-0065-3

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Abstract

Guidelines for management of chronic obstructive pulmonary disease (COPD) primarily focus on the prevention of weight loss, while overweight and obesity are highly prevalent in patients with milder stages of COPD. This cross-sectional study examines the association of overweight and obesity with the prevalence of comorbid disorders and prescribed medication for obstructive airway disease, in patients with mild to moderate COPD. Data were used from electronic health records of 380 Dutch general practices in 2014. In total, we identified 4938 patients with mild or moderate COPD based on spirometry data, and a recorded body mass index (BMI) of ≥21 kg/m2. Outcomes in overweight (BMI ≥ 25 and <30 kg/m2) and obese (BMI ≥30 kg/m2) patients with COPD were compared to those with a normal weight (BMI ≥ 21 and <25 kg/m2), by logistic multilevel analyses. Compared to COPD patients with a normal weight, positive associations were found for diabetes, osteoarthritis, and hypertension, for both overweight (OR: 1.4–1.7) and obese (OR: 2.4–3.8) patients, and for heart failure in obese patients (OR: 2.3). Osteoporosis was less prevalent in overweight (OR: 0.7) and obese (OR: 0.5) patients, and anxiety disorders in obese patients (OR: 0.5). No associations were found for coronary heart disease, stroke, sleep disturbance, depression, and pneumonia. Furthermore, obese patients were in general more often prescribed medication for obstructive airway disease compared to patients with a normal weight. The findings of this study underline the need to increase awareness in general practitioners for excess weight in patients with mild to moderate COPD.

Highlights

Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease.[1]
Initially 46,803 patients were detected in the NIVEL Primary Care Database (NIVEL-PCD) with a diagnosis of COPD prior to 1st January 2014, of which 20,777 (44%) had a body mass index (BMI) recorded and 7890 (17%) had a spirometry result in 2014
For the comparison of overweight and obese patients with the normalweight patients, adjusted odds ratios (ORs) for comorbid disorders are shown in Fig. 2 for the main analyses

Summary

Introduction

Chronic obstructive pulmonary disease (COPD) is a highly prevalent chronic disease.[1] weight loss is common in patients with COPD, previous studies have shown that about 65% of the COPD population is overweight or obese.[2,3,4,5] Obesity is a well-known risk factor for several diseases, such as diabetes mellitus and cardiovascular diseases, in patients with COPD.[6,7] obesity in patients with COPD is associated with several other health consequences, like increased symptoms of dyspnea, a higher prescription rate for inhaled medications, and increased healthcare utilization.[3,8,9,10] the global initiative for chronic obstructive lung disease (GOLD) that provides evidence for the assessment, diagnoses, and treatment of COPD, primarily focus on the prevention of weight loss,[11] as underweight in patients with COPD is associated with a higher risk of all-cause mortality.[12] this mostly applies to patients with severe COPD where an increasing body mass index (BMI) is linearly associated with a better survival, while in patients with mild to moderate COPD the lowest mortality risk occurs in normal to overweight patients.[13,14]

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