In obese patients with chronic obstructive pulmonary disease (COPD), cardiovascular and metabolic comorbidities, particularly hypertension and diabetes, are highly prevalent, and active screening for these disorders should be a priority among healthcare professionals who treat obese patients with COPD. A cohort study on the subject was conducted in the outpatient clinic of Rijnstate Hospital, a large teaching hospital in Arnhem, The Netherlands. Findings were published in COPD.
Investigators sought to evaluate the prevalence of obesity in a secondary care population of patients with COPD. In addition, they explored the presence of comorbidities in obese (COPDOB) and nonobese (COPDNO) individuals with COPD. Patient characteristics, comorbidities, and pulmonary function tests were obtained from the medical records of 1654 patients ≥18 years of age with COPD who had visited a pulmonologist between January 2015 and December 2015.
All participants were classified according to their body mass index (BMI), as follows: underweight, BMI <18.5 kg/m2; normal weight, BMI 18.5 to 24.99 kg/m2; overweight, BMI 25.0 to 29.99 kg/m2; or obese, BMI ≥30.0 kg/m2. The Charlson Comorbidity Index and COPD Comorbidity Test index were used to quantify comorbidities.
In the COPD population, the prevalence of obesity was 21.8%, which was more than 4 times the prevalence of being underweight (5.1%). Furthermore, 40.7% of the participants were of normal weight and 32.4% were overweight. Obesity was significantly less common in those with Global Initiative for Chronic Obstructive Lung Disease (GOLD) stage IV (10.1%) compared with patients with GOLD stage I (20.5%), GOLD stage II (27.8%), and GOLD stage III (18.9%; P <.05 for all).
Individuals with COPDOB had comorbidities that differed from those with COPDNO. Diabetes, hypertension, congestive heart failure, and atrial fibrillation were all significantly more prevalent in patients with COPDOB (P <.05), whereas osteoporosis and lung cancer were significantly more prevalent in those with COPDNO (P <.05).
The investigators concluded that in patients with COPD, the presence of obesity is common. Study results demonstrated that obesity is most prevalent in those with COPD GOLD I and GOLD II, and least prevalent in those with COPD GOLD IV.
A major limitation of the study is the fact that data were evaluated from a single center. A multicenter study would be more appropriate for generalizing these prevalence rates. Future prospective studies with follow-up of patients are warranted to explore causal links.
Zewari S, Hadi L, van den Elshout F, Dekhuijzen R, Heijdra Y, Vos P. Obesity in COPD: comorbidities with practical consequences? COPD. 2018;15(5):464-471.