Combined Effect of Multimorbidity and Increased Body Mass Index on Control of Bronchial Asthma and Quality of Patients’ Life

Abstract

INTRODUCTION: Bronchial asthma (BA) is a serious medical and social problem due to its increasing prevalence, significant burden on healthcare and the persisting high level of disability and mortality.

AIM: To study a combined effect of multimorbidity and increased body mass index (BMI) on BA control and quality of life (QL) of patients to determine the possibilities of optimization of personalized program of patient management.

MATERIALS AND METHODS: Two hundred thirty seven patients with BA were divided to 3 groups: 1 — with normal body weight (n = 59; 24.9%); 2 — with overweight (n = 69; 29.1%); 3 — with obesity (n = 109; 46.0%). The level of multimorbidity was analyzed by Charlson comorbidity Index (CCI) and the cumulative illness rating scale (CIRS); BA control — by ASTTM and ACQ-5; QL — by AQLQ. The average number of groups of comorbid diseases (according to CIRS) was 7.44 ± 0.95, while 13.5% of patients had 1–2 groups of comorbid diseases, 33.8% — 3–4 groups, 46.8% ≥ 5 groups. In the group of obesity, 82.6% of patients had ≥ 5 groups of diseases. The average score of CIRS index was 7.44 ± 0.95 points, the maximum score was 19, the minimum was 2. In the first group, the average value of CIRS index was 4.68 ± 0.31 points, in the second — 5.62 ± 0.43 points, in the third — 10.1 ± 1.9 points (p_{1, 2} = 0.001, p_{1, 3} < 0.0001, p_{2, 3} < 0.0001).

RESULTS: Ten patients (4%) had fully controlled BA by АСТ™ and 33 (14%) — by ACQ-5. In the group with obesity, controlled BA was not detected (÷2 = 34.128; p = 0.0002), (F = 41.362; p < 0.001). With increase in the number of comorbid diseases, the control of BA reliably decreased; thus, in groups 2 and 3 with the existence of ≥ 5 groups of comorbid diseases, asthma had uncontrolled course with the lowest parameters in patients with obesity (р < 0.05). Analysis of BA by AQLQ showed negative influence of the disease on the severity of symptoms, motor activity, general QL of patients with obesity. The data obtained are confirmed by the correlation analysis.

CONCLUSION: Multimorbidity negatively influences control of BA: increase in CCI and CIRS parameters considerably impairs control of BA. Increase in BMI is a significant additional risk factor of impairment of BA control. Multimorbidity in combination with obesity significantly impairs QL of patients with BA according to AQLQ. The absence of control of BA according to АСТ™ and ACQ-5 influences the quality of life of patients with BA. The evaluation of multimorbidity and BMI must be included in the personalized program for management of patients with BA to take into account multivariate assessment of treatable signs of the disease.

Keywords

bronchial asthma / obesity / asthma control / multimorbidity

References

[1] Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet. 2020;396(10258):1204–22. doi: 10.1016/S0140-6736(20)30925-9

[2] Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019 // Lancet. 2020. Vol. 396, No. 10258. P. 1204–1222. doi: 10.1016/S0140-6736(20)30925-9

[3] Chuchalin AG, Khaltaev N, Antonov NS, et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation. International Journal of Chronic Obstructive Pulmonary Disease. 2014;9:963–74. doi: 10.2147/COPD.S67283

[4] Chuchalin A.G., Khaltaev N., Antonov N.S., et al. Chronic respiratory diseases and risk factors in 12 regions of the Russian Federation // International Journal of Chronic Obstructive Pulmonary Disease. 2014. Vol. 9. P. 963–974. doi: 10.2147/COPD.S67283

[5] Salukhov VV, Kharitonov MA, Zaycev AA, et al. The modern significant of the bronchial asthma. Bulletin of the Russian Military Medical Academy. 2020;22(2):227–34. doi: 10.17816/brmma50078

[6] Салухов В.В., Харитонов М.А., Зайцев А.А., и др. Современные представления о бронхиальной астме // Вестник Российской Военно-медицинской академии. 2020. Т. 22, № 2. С. 227–234. doi: 10.17816/brmma50078

[7] Arkhipov VV, Grigoryeva EV, Gavrishina EV. Control of bronchial asthma in Russia: results of NIKA multi-center observational study. Pulmonologiya. 2011;(6):87–93. (In Russ). doi: 10.18093/0869-0189-2011-0-6-87-93

[8] Архипов В.В., Григорьева Е.В., Гавришина Е.В. Контроль над бронхиальной астмой в России: результаты многоцентрового наблюдательного исследования НИКА // Пульмонология. 2011. № 6. С. 87-93. doi: 10.18093/0869-0189-2011-0-6-87-93

[9] Chuchalin AG, Avdeev SN, Aisanov ZR, et al. Federal guidelines on diagnosis and treatment of bronchial asthma. Pulmonologiya. 2022;32(3): 393–447. (In Russ). doi: 10.18093/0869-0189-2022-32-3-393-447

[10] Чучалин А.Г., Авдеев С.Н., Айсанов З.Р., и др. Бронхиальная астма: федеральные клинические рекомендации по диагностике и лечению // Пульмонология. 2022. Т. 32, № 3. С. 393–447. doi: 10.18093/0869-0189-2022-32-3-393-447

[11] Gershon AS, Guan J, Wang C, et al. Describing and quantifying asthma comorbidity [corrected]: a population study. PLoS One. 2012;7(5):e34967. doi: 10.1371/journal.pone.0034967

[12] Gershon A.S., Guan J., Wang C., et al. Describing and quantifying asthma comorbidity [corrected]: a population study // PLoS One. 2012. Vol. 7, No. 5. P. e34967. doi: 10.1371/journal.pone.0034967

[13] Beuther DA, Sutherland ER. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies. American Journal of Respiratory and Critical Care Medicine. 2007;175(7):661–6. doi: 10.1164/rccm.200611-1717OC

[14] Beuther D.A., Sutherland E.R. Overweight, obesity, and incident asthma: a meta-analysis of prospective epidemiologic studies // American Journal of Respiratory and Critical Care Medicine. 2007. Vol. 175, No. 7. P. 661–666. doi: 10.1164/rccm.200611-1717OC

[15] Ermolova AV, Budnevsky AV, Malysh EYu, et al. Bronchial asthma and metabolic syndrome. Clinical Medicine (Russian Journal). 2015;93(6):44–9. (In Russ).

[16] Ермолова А.В., Будневский А.В., Малыш Е.Ю., и др. Клинико- функциональные особенности бронхиальной астмы у больных с метаболическим синдромом // Клиническая медицина. 2015. Т. 93, № 6. С. 44–49.

[17] Arkhipov VV, Aisanov ZR, Avdeev SN. Effectiveness of inhaled corticosteroids and long-acting β-agonists combinations in real clinical practice: results of a multicenter cross-sectional study in Russian patients with asthma. Pulmonologiya. 2021;31(5):613–26. (In Russ). doi: 10.18093/0869-0189-2021-31-5-613-626

[18] Архипов В.В., Айсанов З.P., Авдеев C.Н. Эффективность комбинаций ингаляционных глюкокортикостероидов и длительно действующих β-агонистов в условиях реальной медицинской практики: результаты многоцентрового кросс-секционного исследования у российских пациентов с бронхиальной астмой // Пульмонология. 2021. Т. 31, № 5. С. 613–626. doi: 10.18093/0869-0189-2021-31-5-613-626

[19] Ward ZJ, Long MW, Resch SC, et al. Simulation of growth trajectories of childhood obesity into adulthood. The New England Journal of Medicine. 2017;377(22):2145–53. doi: 10.1056/NEJMoa1703860

[20] Ward Z.J., Long M.W., Resch S.C., et al. Simulation of growth trajectories of childhood obesity into adulthood // The New England Journal of Medicine. 2017. Vol. 377, No. 22. P. 2145–2153. doi: 10.1056/NEJMoa1703860

[21] Pi–Sunyer X. The medical risks of obesity. Postgraduate Medicine. 2009;121(6):21–33. doi: 10.3810/pgm.2009.11.2074

[22] Pi–Sunyer X. The medical risks of obesity // Postgraduate Medicine. 2009. Vol. 121, No. 6. P. 21–33. doi: 10.3810/pgm.2009.11.2074

[23] Ritchie C. Health care quality and multimorbidity: the jury is still out. Medical Care. 2007;45(6):477–9. doi: 10.1097/MLR.0b013e318074d3c1

[24] Ritchie C. Health care quality and multimorbidity: the jury is still out // Medical Care. 2007. Vol. 45, No. 6. P. 477–479. doi: 10.1097/MLR.0b013e318074d3c1

[25] Comorbidities in clinical practice. Algorithms for diagnostics and treatment. Cardiovascular Therapy and Prevention. 2019;18(1):5–66. (In Russ). doi: 10.15829/1728-8800-2019-1-5-66

[26] Коморбидная патология в клинической практике. Алгоритмы диагностики и лечения // Кардиоваскулярная терапия и профилактика. 2019. Т. 18, № 1. С. 5–66. doi: 10.15829/1728-8800-2019-1-5-66

[27] Charlson ME, Pompei P, Ales KL, et al. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of Chronic Diseases. 1987;40(5):373–83. doi: 10.1016/0021-9681(87)90171-8

[28] Charlson M.E., Pompei P., Ales K.L., et al. A new method of classifying prognostic comorbidity in longitudinal studies:development and validation // Journal of Chronic Diseases. 1987. Vol. 40, No. 5. P. 373–383. doi: 10.1016/0021-9681(87)90171-8

[29] Miller MD, Paradis CF, Houck PR, et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale. Psychiatry Research. 1992;41(3):237–48. doi: 10.1016/0165-1781(92)90005-n

[30] Miller M.D., Paradis C.F., Houck P.R., et al. Rating chronic medical illness burden in geropsychiatric practice and research: application of the Cumulative Illness Rating Scale // Psychiatry Research. 1992. Vol. 41, No. 3. P. 237–248. doi: 10.1016/0165-1781(92)90005-n

[31] Provotorov VM, Budnevsky AV, Filatova YI. Clinical manifestations of asthma during combination therapy using ceruloplasmin. Therapeutic Archive. 2016;88(3):36–9. (In Russ). doi: 10.17116/terarkh201688336-39

[32] Провоторов В.М., Будневский А.В., Филатова Ю.И. Клинические проявления бронхиальной астмы под влиянием комплексной терапии с применением церулоплазмина // Терапевтический архив. 2016. Т. 88, № 3. С. 36–39. doi: 10.17116/terarkh201688336-39

[33] Bennett WD, Ivins S, Alexis NE, et al. Effect of Obesity on Acute Ozone-Induced Changes in Airway Function, Reactivity, and Inflammation in Adult Females. PLoS One. 2016;11(8):e0160030. doi: 10.1371/journal.pone.0160030

[34] Bennett W.D., Ivins S., Alexis N.E., et al. Effect of Obesity on Acute Ozone-Induced Changes in Airway Function, Reactivity, and Inflammation in Adult Females // PLoS One. 2016. Vol. 11, No. 8. P. e0160030. doi: 10.1371/journal.pone.0160030

[35] Global Strategy for Asthma Management and Prevention (2022 update). Available at: https://ginasthma.org/wp-content/uploads/2022/05/GINA-2022-Main-Report-Tracked-20220503-WMS.pdf. Accessed: 2023 February 08.

[36] Global Strategy for Asthma Management and Prevention (2022 update). Доступно по: https://ginasthma.org/wp-content/uploads/2022/05/GINA-2022-Main-Report-Tracked-20220503-WMS.pdf. Ссылка активна на 08.02.2023.

[37] Dedov II, Mokrysheva NG, Mel’nichenko GA, et al. Obesity. Clinical guidelines. Consilium Medicum. 2021;23(4):311–25. (In Russ). doi: 10.26442/20751753.2021.4.200832

[38] Дедов И.И., Мокрышева Н.Г., Мельниченко Г.А., и др. Ожирение. Клинические рекомендации // Consilium Medicum. 2021. Т. 23, № 4. С. 311–325. doi: 10.26442/20751753.2021.4.200832

[39] Linn BS, Linn MW, Gurel L. Cumulative Illness Rating Scale. Journal of the American Geriatrics Society. 1968;(16)5:622–6. doi: 10.1111/j.1532-5415.1968.tb02103.x

[40] Linn B.S., Linn M.W., Gurel L. Cumulative Illness Rating Scale // Journal of the American Geriatrics Society. 1968. Vol. 16, No. 5. P. 622–626. doi: 10.1111/j.1532-5415.1968.tb02103.x

[41] Schatz M, Sorkness CA, Li JT, et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. The Journal of Allergy and Clinical Immunology. 2006;117(3):549–56. doi: 10.1016/j.jaci.2006.01.011

[42] Schatz M., Sorkness C.A., Li J.T., et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists // The Journal of Allergy and Clinical Immunology. 2006. Vol. 117, No. 3. P. 549–556. doi: 10.1016/j.jaci.2006.01.011

[43] Juniper EF, O'Byrne PM, Guyatt GH, et al. Development and validation of a questionnaire to measure asthma control. The European Respiratory Journal. 1999;14(4):902–7. doi: 10.1034/j.1399-3003.1999.14d29.x

[44] Juniper E.F., O'Byrne P.M., Guyatt G.H., et al. Development and validation of a questionnaire to measure asthma control // The European Respiratory Journal. 1999. Vol. 14, No. 4. P. 902–907. doi: 10.1034/j.1399-3003.1999.14d29.x

[45] Juniper EF, Buist AS, Cox FM, et al. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest. 1999;115(5):1265–70. doi: 10.1378/chest.115.5.1265

[46] Juniper E.F., Buist A.S., Cox F.M., et al. Validation of a standardized version of the Asthma Quality of Life Questionnaire // Chest. 1999. Vol. 115, No. 5. P. 1265–1270. doi: 10.1378/chest.115.5.1265

[47] Uryasev OM, Panfilov YA. Relative assessment of clinical and functional characteristics and analysis of efficiency of antiasthmatic therapy patients with normal body mass and obesity. Nauka Molodykh (Eruditio Juvenium). 2013;(4):81–90. (In Russ).

[48] Урясьев О.М., Панфилов Ю.А. Влияние ожирения на клинико-функциональные показатели и эффективность противоастматической терапии у больных бронхиальной астмой // Наука молодых (Eruditio Juvenium). 2013. № 4. С. 81–90.

[49] Althoff MD, Ghincea A, Wood LG, et al. Asthma and Three Colinear Comorbidities: Obesity, OSA, and GERD. The Journal of Allergy and Clinical Immunology. In Practice. 2021;9(11):3877–84. doi: 10.1016/j.jaip.2021.09.003

[50] Althoff M.D., Ghincea A., Wood L.G., et al. Asthma and Three Colinear Comorbidities: Obesity, OSA, and GERD // The Journal of Allergy and Clinical Immunology. In Practice. 2021. Vol. 9, No. 11. P. 3877–3884. doi: 10.1016/j.jaip.2021.09.003

[51] Avdeev SN, Nenasheva NM, Zhudenkov KV, et al. Prevalence, morbidity, phenotypes and other characteristics of severe bronchial asthma in Russian Federation. Pulmonologiya. 2018;28(3):341–58. (In Russ). doi: 10.18093/0869-0189-2018-28-3-341-358

[52] Авдеев С.Н., Ненашева Н.М., Жуденков К.В., и др. Распространенность, заболеваемость, фенотипы и другие характеристики тяжелой бронхиальной астмы в Российской Федерации // Пульмонология. 2018. Т. 28, № 3. С. 341–358. doi: 10.18093/0869-0189-2018-28-3-341-358

[53] Weatherburn CJ, Guthrie B, Mercer SW, et al. Comorbidities in adults with asthma: Populationbased cross-sectional analysis of 1.4 million adults in Scotland. Clinical and Experimental Allergy. 2017;47(10):1246–52. doi: 10.1111/cea.12971

[54] Weatherburn C.J., Guthrie B., Mercer S.W., et al. Comorbidities in adults with asthma: Populationbased cross-sectional analysis of 1.4 million adults in Scotland // Clinical and Experimental Allergy. 2017. Vol. 47, No. 10. P. 1246–1252. doi: 10.1111/cea.12971

[55] Mindlis I, Wisnivesky JP, Wolf MS, et al. Comorbidities and depressive symptoms among older adults with asthma. The Journal of Asthma. 2022;59(5):910–6. doi: 10.1080/02770903.2021.1887890

[56] Mindlis I., Wisnivesky J.P., Wolf M.S., et al. Comorbidities and depressive symptoms among older adults with asthma // The Journal of Asthma. 2022. Vol. 59, No. 5. P. 910–916. doi: 10.1080/02770903.2021.1887890

[57] Hekking P–P, Amelink M, Wener RR, et al. Comorbidities in Difficult-to-Control Asthma. The Journal of Allergy and Clinical Immunology. In Practice. 2018;6(1):108–13. doi: 10.1016/j.jaip.2017.06.008

[58] Hekking P.–P., Amelink M., Wener R.R., et al. Comorbidities in Difficult-to-Control Asthma // The Journal of Allergy and Clinical Immunology. In Practice. 2018. Vol. 6, No. 1. P. 108–113. doi: 10.1016/j.jaip.2017.06.008

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