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Obesity and COPD exacerbations – it's not that simple
Respiratory Medicine xxx (2016) 1
Contents lists available at ScienceDirect
Respiratory Medicine journal homepage: www.elsevier.com/locate/rmed
Correspondence
Obesity and COPD exacerbations e it's not that simple Keywords: Obesity COPD exacerbations Overweight Body mass index
We also mention a recent article that concluded that genetically determined high BMI was associated with an increased risk of exacerbation of COPD, but observationally determined high BMI was not [5]. More scientific research will likely be available soon on this topic. Conflict of interest Authors declares no conflict of interest.
Dear Editor, We read with great interest a recent article by Stoll et al., published on your journal, suggesting that being overweight is a predictor for long term survival in chronic obstructive pulmonary disease (COPD) exacerbations [1]. This is important for physicians as hospitalizations for COPD are increasing and death rate is predicted to increase as well. These patients are not simple, as different factors such as age, weight and comorbidities correlate with mortality from COPD exacerbations in the short and long term and after ICU admission. In the end, all of those factors should be taken into account when making clinical decisions about COPD patients [2]. Regarding Obesity, it has been known that it might have a positive impact on some medical conditions [3], such as COPD. This has been called in literature the “obesity-survival paradox”. This is a hot topic, as patients with both obesity and chronic obstructive pulmonary disease have been increasing. We have some key practical comments for proper clinical extrapolation. First, the authors described severe COPD exacerbations, but excluded patients that needed endotracheal intubation or who were transferred to intensive care unit (ICU). In this context, it is not easy to define what is a severe exacerbation. Shouldn't an exacerbation that needed intubation be qualified as a severe? We hope this is taken into account in further studies. Second, it is common knowledge that underweight is associated with bad prognosis in these patients. However, should we use body mass index (BMI)? Some reports suggest that although both weight and BMI are useful for screening on COPD, fat-free mass (FFM) may be a better marker of undernutrition in patients with COPD. There is also some research regarding concepts of metabolically healthy obesity (BMI 30 but not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5) and metabolically obese normal weight [4]. Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FFM, fat-free mass; ICU, intensive care unit.
Funding There is no funding to report.
References [1] P. Stoll, S. Foerster, J.C. Virchow, M. Lommatzsch, Overweight is a predictor of long-term survival in hospitalised patients with exacerbations of COPD, Respir. Med. 116 (2016 Jul) 59e62, http://dx.doi.org/10.1016/j.rmed.2016.05.016. Epub 2016 May 17. [2] A. Singanayagam, S. Schembri, J.D. Chalmers, Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease, Ann. Am. Thorac. Soc. 10 (2) (2013 Apr) 81e89, http://dx.doi.org/10.1513/AnnalsATS.201208-043OC. [3] D.J. Pepper, J. Sun, J. Welsh, X. Cui, A.F. Suffredini, P.Q. Eichacker, Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis, Crit. Care 20 (2016) 181, http://dx.doi.org/ 10.1186/s13054-016-1360-z. [4] O. e Bosello, M.P. Donataccio, M. Cuzzolaro, Obesity or obesities? Controversies on the association between body mass index and premature mortality, Eat. Weight Disord. 21 (2) (2016 Jun) 165e174, http://dx.doi.org/10.1007/s40519016-0278-4. [5] Y. Çolak, S. Afzal, P. Lange, B.G. Nordestgaard, High body mass index and risk of exacerbations and pneumonias in individuals with chronic obstructive pulmonary disease: observational and genetic risk estimates from the Copenhagen General Population Study, Int. J. Epidemiol. (2016 Apr 26), http://dx.doi.org/ 10.1093/ije/dyw051. PMID: 27118560.
Joao Cravo* rio de Coimbra, Serviço Pneumologia A, Centro Hospitalar e Universita Portugal Antonio M. Esquinas Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain E-mail address: [email protected]. *
Corresponding author. Pneumologia A, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. E-mail address: [email protected] (J. Cravo). 22 June 2016 Available online xxx
http://dx.doi.org/10.1016/j.rmed.2016.08.002 0954-6111/© 2016 Elsevier Ltd. All rights reserved.
Please cite this article in press as: J. Cravo, A.M. EsquinasObesity and COPD exacerbations e it's not that simple, Respiratory Medicine (2016), http://dx.doi.org/10.1016/j.rmed.2016.08.002
Contents lists available at ScienceDirect
Respiratory Medicine journal homepage: www.elsevier.com/locate/rmed
Correspondence
Obesity and COPD exacerbations e it's not that simple Keywords: Obesity COPD exacerbations Overweight Body mass index
We also mention a recent article that concluded that genetically determined high BMI was associated with an increased risk of exacerbation of COPD, but observationally determined high BMI was not [5]. More scientific research will likely be available soon on this topic. Conflict of interest Authors declares no conflict of interest.
Dear Editor, We read with great interest a recent article by Stoll et al., published on your journal, suggesting that being overweight is a predictor for long term survival in chronic obstructive pulmonary disease (COPD) exacerbations [1]. This is important for physicians as hospitalizations for COPD are increasing and death rate is predicted to increase as well. These patients are not simple, as different factors such as age, weight and comorbidities correlate with mortality from COPD exacerbations in the short and long term and after ICU admission. In the end, all of those factors should be taken into account when making clinical decisions about COPD patients [2]. Regarding Obesity, it has been known that it might have a positive impact on some medical conditions [3], such as COPD. This has been called in literature the “obesity-survival paradox”. This is a hot topic, as patients with both obesity and chronic obstructive pulmonary disease have been increasing. We have some key practical comments for proper clinical extrapolation. First, the authors described severe COPD exacerbations, but excluded patients that needed endotracheal intubation or who were transferred to intensive care unit (ICU). In this context, it is not easy to define what is a severe exacerbation. Shouldn't an exacerbation that needed intubation be qualified as a severe? We hope this is taken into account in further studies. Second, it is common knowledge that underweight is associated with bad prognosis in these patients. However, should we use body mass index (BMI)? Some reports suggest that although both weight and BMI are useful for screening on COPD, fat-free mass (FFM) may be a better marker of undernutrition in patients with COPD. There is also some research regarding concepts of metabolically healthy obesity (BMI 30 but not having any metabolic syndrome component and having a homeostasis model assessment of insulin resistance <2.5) and metabolically obese normal weight [4]. Abbreviations: BMI, body mass index; COPD, chronic obstructive pulmonary disease; FFM, fat-free mass; ICU, intensive care unit.
Funding There is no funding to report.
References [1] P. Stoll, S. Foerster, J.C. Virchow, M. Lommatzsch, Overweight is a predictor of long-term survival in hospitalised patients with exacerbations of COPD, Respir. Med. 116 (2016 Jul) 59e62, http://dx.doi.org/10.1016/j.rmed.2016.05.016. Epub 2016 May 17. [2] A. Singanayagam, S. Schembri, J.D. Chalmers, Predictors of mortality in hospitalized adults with acute exacerbation of chronic obstructive pulmonary disease, Ann. Am. Thorac. Soc. 10 (2) (2013 Apr) 81e89, http://dx.doi.org/10.1513/AnnalsATS.201208-043OC. [3] D.J. Pepper, J. Sun, J. Welsh, X. Cui, A.F. Suffredini, P.Q. Eichacker, Increased body mass index and adjusted mortality in ICU patients with sepsis or septic shock: a systematic review and meta-analysis, Crit. Care 20 (2016) 181, http://dx.doi.org/ 10.1186/s13054-016-1360-z. [4] O. e Bosello, M.P. Donataccio, M. Cuzzolaro, Obesity or obesities? Controversies on the association between body mass index and premature mortality, Eat. Weight Disord. 21 (2) (2016 Jun) 165e174, http://dx.doi.org/10.1007/s40519016-0278-4. [5] Y. Çolak, S. Afzal, P. Lange, B.G. Nordestgaard, High body mass index and risk of exacerbations and pneumonias in individuals with chronic obstructive pulmonary disease: observational and genetic risk estimates from the Copenhagen General Population Study, Int. J. Epidemiol. (2016 Apr 26), http://dx.doi.org/ 10.1093/ije/dyw051. PMID: 27118560.
Joao Cravo* rio de Coimbra, Serviço Pneumologia A, Centro Hospitalar e Universita Portugal Antonio M. Esquinas Intensive Care Unit, Hospital Morales Meseguer, Murcia, Spain E-mail address: [email protected]. *
Corresponding author. Pneumologia A, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal. E-mail address: [email protected] (J. Cravo). 22 June 2016 Available online xxx
http://dx.doi.org/10.1016/j.rmed.2016.08.002 0954-6111/© 2016 Elsevier Ltd. All rights reserved.
Please cite this article in press as: J. Cravo, A.M. EsquinasObesity and COPD exacerbations e it's not that simple, Respiratory Medicine (2016), http://dx.doi.org/10.1016/j.rmed.2016.08.002