Mortality and Exacerbation Risk by Body Mass Index in Patients with COPD in TIOSPIR® and UPLIFT®.
Nirupama PutchaAntonio R AnzuetoPeter M A CalverleyBartolomé R CelliDonald P TashkinNorbert MetzdorfAchim MuellerRobert A WisePublished in: Annals of the American Thoracic Society (2021)
Rationale: There is an association between body mass index (BMI) and mortality in chronic obstructive pulmonary disease (COPD), with underweight individuals having higher mortality risk. Mortality and exacerbation risks among individuals with higher BMI are unclear. Objective: To examine the relationship between BMI and adverse outcomes in COPD. Methods: This post hoc analysis included data from Tiotropium Safety and Performance in Respimat® (TIOSPIR®) (N=17,116) and tiotropium-treated patients in Understanding Potential Long-term Impacts on Function with Tiotropium (UPLIFT®) (N=2986). BMI classes (underweight [BMI <20 kg/m2], normal weight [BMI 20-<25 kg/m2], overweight [BMI 25-<30 kg/m2], obesity class I [BMI 30-<35 kg/m2], obesity class II [BMI 35-<40 kg/m2] and obesity class III [BMI ≥40 kg/m2]) were examined for adjusted associations with mortality, exacerbation and non-fatal cardiovascular event risk using over 50,000 patient-years of cumulative follow-up data. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated using Cox regression models. Results: In TIOSPIR®, obesity prevalence was 22%, overweight 32%, and underweight 12%. The proportion of females was highest in obesity classes II and III. Overweight and obese participants had better baseline lung function versus other BMI classes; underweight participants were more likely to be current smokers. Underweight participants had a significantly higher risk of death (HR 1.88, 95% CI 1.62-2.20; p<0.0001) and severe exacerbations (HR 1.31, 95% CI 1.16-1.47; p<0.0001) versus normal-weight participants; however, overweight and obese participants were at lower to no additional risk. Results from UPLIFT® were similar to TIOSPIR®. Conclusion: These results suggest that there is a strong association between body weight, COPD events and risk of death. A holistic management approach taking into account respiratory and cardiovascular risk factors and nutritional status is needed to improve the general well-being of patients with COPD.
Keyphrases
- weight gain
- body mass index
- chronic obstructive pulmonary disease
- lung function
- weight loss
- metabolic syndrome
- physical activity
- cardiovascular risk factors
- insulin resistance
- cystic fibrosis
- cardiovascular events
- body weight
- clinical trial
- type diabetes
- risk factors
- end stage renal disease
- air pollution
- high fat diet induced
- newly diagnosed
- ejection fraction
- artificial intelligence
- coronary artery disease
- electronic health record
- intensive care unit
- chronic kidney disease
- case report
- adipose tissue
- drug induced
- prognostic factors
- respiratory failure