• Allison A Lambert, Nirupama Putcha, M Bradley Drummond, Aladin M Boriek, Nicola A Hanania, Victor Kim, Gregory L Kinney, McDonaldMerry-Lynn NMNChanning Division of Network Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA., Emily P Brigham, Robert A Wise, Meredith C McCormack, Nadia N Hansel, and COPDGene Investigators.
• Department of Medicine, Division of Pulmonary and Critical Care, Johns Hopkins University, Baltimore, MD. Electronic address: alamber5@jhmi.edu.
• Chest. 2017 Jan 1; 151 (1): 68-77.

BackgroundObesity is prevalent in the United States; however, the impact of obesity on COPD morbidity is unclear. We hypothesized that obesity is associated with worse outcomes in COPD.MethodsWe examined 3,631 participants from the multicenter prospective cohort study Genetic Epidemiology of COPD (COPDGene) who had spirometry-confirmed COPD, a postbronchodilator FEV1 < 80% predicted, and a BMI ≥ 18.5 kg/m2. We conducted logistic and linear regression analyses to determine the association between COPD outcomes and obesity class, adjusting for relevant confounders. The referent for obesity classes included normal/overweight individuals (BMI range, 18.5-29.9 kg/m2).ResultsOverall, 35% of participants were obese, with 21% class I (BMI range, 30-34.9 kg/m2), 9% class II (BMI range, 35-39.9 kg/m2), and 5% class III (BMI ≥ 40 kg/m2). The number of comorbidities increased with increasing obesity class (P < .001). Increasing obesity class was independently associated with worse respiratory-specific and general quality of life (QOL) (St. George's Respiratory Questionnaire score and Short Form-36 score version 2, respectively), reduced 6-min walk distance (6MWD), increased dyspnea (Modified Medical Research Council score ≥ 2), and greater odds of severe acute exacerbation of COPD (AECOPD). The associations between obesity and worse outcomes were independent of the presence of comorbidities, except in the case of SF-36 and severe exacerbations.ConclusionsObesity is prevalent among individuals with COPD and associated with worse COPD-related outcomes, ranging from QOL and dyspnea to 6MWD and severe AECOPD. These associations were strengthened when obesity was analyzed as a dose-dependent response. Obesity in patients with COPD may contribute to a worse COPD-related course.Copyright © 2016 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.

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