Elsevier

Respiratory Medicine

Volume 101, Issue 11, November 2007, Pages 2240-2247
Respiratory Medicine

Influence of obesity on response to fluticasone with or without salmeterol in moderate asthma

https://doi.org/10.1016/j.rmed.2007.06.031Get rights and content
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Summary

Rationale

Obesity may contribute to the development and clinical expression of asthma. However, how obesity can influence response to asthma medications is still uncertain.

Objectives

To examine the relationship between body mass index (BMI) and the response to an inhaled corticosteroid (ICS), fluticasone propionate, with or without the long-acting β2-agonist salmeterol (LABA).

Methods

Achievement of asthma control as defined by the global initiative on asthma guidelines (GINA) was examined in 1242 asthmatic patients not currently using ICS, enrolled in five clinical trials comparing fluticasone propionate and the combination of fluticasone and salmeterol.

Results

In both obese and non-obese subjects, fluticasone propionate combined with salmeterol was more effective in controlling asthma than fluticasone alone. However, for both treatments the odds of achieving well-controlled asthma were significantly lower in obese subjects, particularly among those with a BMI of ⩾40 kg/m2. Reported prevalence of atopy increased with BMI. Age did not influence the effect of obesity in response to asthma medications.

Conclusion

Obese patients are less likely than the non-obese to achieve asthma control with an ICS or an ICS combined with a LABA. The causes of such reduced response to asthma medication in obese subjects should be studied, and their implications for asthma therapy determined.

KEYWORDS

Asthma
Obesity
Body mass index
Asthma medications

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