A 1-Year Weight Management Program for Difficult-to-Treat Asthma With Obesity: A Randomized Controlled Study.

IF 9.5 1区 医学 Q1 CRITICAL CARE MEDICINE Chest Pub Date : 2025-01-01 Epub Date: 2024-10-18 DOI:10.1016/j.chest.2024.09.042
Varun Sharma, Helen Clare Ricketts, Louise McCombie, Naomi Brosnahan, Luisa Crawford, Lesley Slaughter, Anna Goodfellow, Femke Steffensen, Rekha Chaudhuri, Michael E J Lean, Douglas C Cowan
{"title":"A 1-Year Weight Management Program for Difficult-to-Treat Asthma With Obesity: A Randomized Controlled Study.","authors":"Varun Sharma, Helen Clare Ricketts, Louise McCombie, Naomi Brosnahan, Luisa Crawford, Lesley Slaughter, Anna Goodfellow, Femke Steffensen, Rekha Chaudhuri, Michael E J Lean, Douglas C Cowan","doi":"10.1016/j.chest.2024.09.042","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Obesity-associated asthma results in increased morbidity and mortality. We report 1-year asthma outcomes with a weight management regimen, the Counterweight-Plus Programme (CWP), compared with usual care (UC) in a single-center, randomized controlled trial in patients with difficult-to-treat asthma and obesity.</p><p><strong>Research question: </strong>Can use of the CWP result in improved asthma control and quality of life compared with UC at 1 year in patients with difficult-to-treat asthma and obesity?</p><p><strong>Study design and methods: </strong>Adults with difficult-to-treat asthma and BMI ≥ 30 kg/m<sup>2</sup> were randomized (1:1 CWP:UC) to treatment. The CWP, with dietitian support, included a 12-week total diet replacement phase (850 kcal/d low-energy formula), and then subsequent food reintroduction and maintenance phases up to 1 year. Outcomes include results of the six-item Asthma Control Questionnaire (ACQ-6) and Asthma Quality of Life Questionnaire (AQLQ), as well as health care usage. A minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.</p><p><strong>Results: </strong>Of 36 patients recruited, 29 attended visits at 52 weeks (13 CWP and 16 UC). The CWP resulted in greater weight change (median, -14 kg [interquartile range (IQR), -15 to -9 kg]) compared with UC (median, 2 kg [IQR, -7 to 8 kg]; P = .015) at 52 weeks. A greater proportion achieved MCID with the CWP vs UC in AQLQ (71% vs 6%, respectively; P < .001). No between-group differences were observed in ACQ-6. Median exacerbation frequency was reduced over 52 weeks with the CWP from 4 (IQR, 2 to 5) to 0 (IQR, 0 to 2) (P < .001), although no between-group difference was observed. Seventy percent of the CWP group lost ≥ 10% body weight and had improvement in ACQ-6 (mean difference, -1.1; 95% CI, -1.9 to -0.3; P = .018) and AQLQ (mean difference, 1.2; 95% CI, 0.4, 2.1; P = .011) across 52 weeks.</p><p><strong>Interpretation: </strong>In this study, the use of a dietitian-supported weight management program resulted in sustained weight loss and is a potential treatment for obesity in asthma. The CWP resulted in a higher proportion achieving MCID improvements in AQLQ compared with UC. Within-group differences in AQLQ and exacerbation frequency suggest potential with the CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.</p>","PeriodicalId":9782,"journal":{"name":"Chest","volume":" ","pages":"42-53"},"PeriodicalIF":9.5000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11752128/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.09.042","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/10/18 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
引用次数: 0

Abstract

Background: Obesity-associated asthma results in increased morbidity and mortality. We report 1-year asthma outcomes with a weight management regimen, the Counterweight-Plus Programme (CWP), compared with usual care (UC) in a single-center, randomized controlled trial in patients with difficult-to-treat asthma and obesity.

Research question: Can use of the CWP result in improved asthma control and quality of life compared with UC at 1 year in patients with difficult-to-treat asthma and obesity?

Study design and methods: Adults with difficult-to-treat asthma and BMI ≥ 30 kg/m2 were randomized (1:1 CWP:UC) to treatment. The CWP, with dietitian support, included a 12-week total diet replacement phase (850 kcal/d low-energy formula), and then subsequent food reintroduction and maintenance phases up to 1 year. Outcomes include results of the six-item Asthma Control Questionnaire (ACQ-6) and Asthma Quality of Life Questionnaire (AQLQ), as well as health care usage. A minimal clinically important difference (MCID) is 0.5 for ACQ-6 and AQLQ.

Results: Of 36 patients recruited, 29 attended visits at 52 weeks (13 CWP and 16 UC). The CWP resulted in greater weight change (median, -14 kg [interquartile range (IQR), -15 to -9 kg]) compared with UC (median, 2 kg [IQR, -7 to 8 kg]; P = .015) at 52 weeks. A greater proportion achieved MCID with the CWP vs UC in AQLQ (71% vs 6%, respectively; P < .001). No between-group differences were observed in ACQ-6. Median exacerbation frequency was reduced over 52 weeks with the CWP from 4 (IQR, 2 to 5) to 0 (IQR, 0 to 2) (P < .001), although no between-group difference was observed. Seventy percent of the CWP group lost ≥ 10% body weight and had improvement in ACQ-6 (mean difference, -1.1; 95% CI, -1.9 to -0.3; P = .018) and AQLQ (mean difference, 1.2; 95% CI, 0.4, 2.1; P = .011) across 52 weeks.

Interpretation: In this study, the use of a dietitian-supported weight management program resulted in sustained weight loss and is a potential treatment for obesity in asthma. The CWP resulted in a higher proportion achieving MCID improvements in AQLQ compared with UC. Within-group differences in AQLQ and exacerbation frequency suggest potential with the CWP. These encouraging signals justify a larger sample study to further assess asthma-related outcomes.

查看原文
分享 分享
微信好友 朋友圈 QQ好友 复制链接
本刊更多论文
针对难治性肥胖哮喘的为期一年的体重管理计划:随机对照研究。
背景:肥胖引起的哮喘会增加发病率和死亡率。我们报告了在一项单中心随机对照试验中,Counterweight-Plus 体重管理计划(CWP)与常规护理(UC)相比,对难以治疗的哮喘和肥胖患者一年的哮喘治疗结果:研究问题:对于难以治疗的哮喘和肥胖症患者,使用 CWP 一年后,其哮喘控制率和生活质量能否比常规护理有所提高?我们对哮喘难以治愈且体重指数≥30kg/m2的成人患者进行了随机分组(1:1 CWP:UC)。有营养师支持的 CWP:为期 12 周的全面饮食替代阶段(850 千卡/天的低能量配方);食物再引入和维持阶段,最长一年。结果包括哮喘控制问卷(ACQ-6)、哮喘生活质量问卷(AQLQ)和医疗保健使用情况。ACQ-6 和 AQLQ 的最小临床重要差异(MCID)为 0.5:在招募的 36 人中,29 人参加了 52 周的治疗:13 人参加了 CWP,16 人参加了 UC。在 52 周时,CWP 与 UC(2 千克 [-7, 8];P=0.015)相比,体重变化更大(中位数 -14 千克 [IQR -15, -9])。CWP与UC相比,在AQLQ方面达到MCID的比例更高(分别为71%对6%;P解释:使用营养师支持的体重管理计划可持续减轻体重,是治疗哮喘患者肥胖症的一种潜在方法。与 UC 相比,CWP 可使更高比例的患者在 AQLQ 方面获得 MCID 改善。AQLQ和恶化频率的组内差异表明,CWP具有潜力。这些令人鼓舞的信号表明,有必要进行更大规模的样本研究,以进一步评估与哮喘相关的结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 去求助
来源期刊
Chest
Chest 医学-呼吸系统
CiteScore
13.70
自引率
3.10%
发文量
3369
审稿时长
15 days
期刊介绍: At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.
期刊最新文献
Association between preserved ratio impaired spirometry (PRISm) and COPD with coronary artery calcification measured by coronary computed tomography. PRISm is an important risk factor for development of COPD, also in non-smokers. DIAGNOSTIC EVALUATION AND CLINICAL FINDINGS IN CHILDREN WITH PERSISTENT TACHYPNEA OF INFANCY/NEUROENDOCRINE CELL HYPERPLASIA OF INFANCY: A EUROPEAN MULTICENTER RETROSPECTIVE STUDY. Prevalence of Airflow Limitation and Emphysema in Lung Cancer Screening Populations: A Systematic Review and Meta-analysis. Changes in Lung Function and Mortality Risk in Patients With Idiopathic Pulmonary Fibrosis.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
现在去查看 取消
×
提示
确定
0
微信
客服QQ
Book学术公众号 扫码关注我们
反馈
×
意见反馈
请填写您的意见或建议
请填写您的手机或邮箱
已复制链接
已复制链接
快去分享给好友吧!
我知道了
×
扫码分享
扫码分享
Book学术官方微信
Book学术文献互助
Book学术文献互助群
群 号:481959085
Book学术
文献互助 智能选刊 最新文献 互助须知 联系我们:info@booksci.cn
Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。
Copyright © 2023 Book学术 All rights reserved.
ghs 京公网安备 11010802042870号 京ICP备2023020795号-1