Body Mass Index Less Than 30 as a Predictor of Near Fatal Asthma.

SESSION TYPE: Asthma Predictors and OutcomesPRESENTED ON: Wednesday, October 24, 2012 at 02:45 PM - 04:15 PMPURPOSE: Obesity is associated with an increased risk for asthma exacerbations and represents an understudied phenotype. However, little is known with regards to the association of BMI and near fatal Asthma (NFA)METHODS: We conducted a retrospective analysis of patients who were discharged from the hospital with a diagnosis of acute asthma exacerbation. Patients who required intubation during the course of their hospitalization were defined as NFA and the rest were analyzed collectively as non near-fatal asthma (non-NFA). A head to head comparison was done between asthmatics with BMI>30(non-obese) and those with BMI<30(obese). Multiple parameters, which included patient demographics as well as severity indicators, were compared between the two groups.RESULTS: Of the total 218 individuals evaluated in the study, 127 individuals had BMI<30 and 91 individuals with BMI>30. No fatalities were noted. The 2 groups did not differ in terms of Age, sex, race, history of smoking, length of ICU or Hospital Stay, duration of Mechanical Ventilation, past history of ICU or hospital admission or history of previous intubations, , use of B agonist therapy(short & long acting) and corticosteroid therapy(inhaled & systemic) prior to admission. Recreational drug use (cocaine & Heroine) was seen more commonly in individuals with BMI<30(46.5% v/s 28.6%; P=0.008); Asthmatics with BMI<30 were more acidotic (ph of 7.31 vs. 7.35 p=0.008). However, 64 patients of the 218 required invasive ventilation. 46 (36.2%; 46/127) were in the BMI<30 group ventilation and 18(19.8%; 18/91) did so in the obese group (p=0.009). After adjusting for age, sex, recreational drug use, history of smoking, history of intubation, history of hospital or ICU admission, having a Primary Care doctor, pH<7.35, PCO2 >45 mm Hg on the initial blood gas & FiO2 requirement > 40%, BMI<30 still remained significant as a predictor of near fatal asthma over obesity (p<0.05).CONCLUSIONS: Near fatal asthma was seen more frequently in the BMI<30 group than in the obese group during acute asthma exacerbation.CLINICAL IMPLICATIONS: Obesity is a major risk factor for asthma and asthma is difficult to control in obsese patients .However,as per our study,obese did better than non-obese during acute asthma exacerbation.DISCLOSURE: The following authors have nothing to disclose: Viral Doshi, Sundeep Shenoy, Adeel Rishi, Aarthi Ganesh, Gargi Shah, Shilpa Lankala, Janos MolnarNo Product/Research Disclosure InformationChicago Medical School /Rosalind Franklin University of Medicine and Science, North Chicago, IL.