Persistent Uncontrolled Asthma: Long-Term Impact on Physical Activity and Body Composition

Mustafa Abdo; Benjamin Waschki; Anne-Marie Kirsten; Frederik Trinkmann; Heike Biller; Christian Herzmann; Erika von Mutius; Matthias Kopp; Gesine Hansen; Klaus F Rabe; Thomas Bahmer; Henrik Watz; ALLIANCE study group

doi:10.2147/JAA.S299756

Persistent Uncontrolled Asthma: Long-Term Impact on Physical Activity and Body Composition

J Asthma Allergy. 2021 Mar 12:14:229-240. doi: 10.2147/JAA.S299756. eCollection 2021.

Authors

Mustafa Abdo¹, Benjamin Waschki², Anne-Marie Kirsten³, Frederik Trinkmann^{4

5}, Heike Biller¹, Christian Herzmann⁶, Erika von Mutius⁷, Matthias Kopp^{8

9}, Gesine Hansen¹⁰, Klaus F Rabe¹, Thomas Bahmer^#^{1

11}, Henrik Watz^#³; ALLIANCE study group

Affiliations

¹ LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
² Department of Cardiology and Pneumology at Hospital Itzehoe, Itzehoe, Germany.
³ Pulmonary Research Institute at the LungenClinic Grosshansdorf, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Grosshansdorf, Germany.
⁴ Department of Pneumology and Critical Care Medicine, Thoraxklinik, University of Heidelberg, Translational Lung Research Center Heidelberg (TLRC), German Center for Lung Research (DZL), Heidelberg, Germany.
⁵ Department of Biomedical Informatics, Heinrich-Lanz-Center, University Medical Center Mannheim, Heidelberg University, Heidelberg, Germany.
⁶ Research Center Borstel, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Borstel, Germany.
⁷ Dr von Hauner Children's Hospital, Ludwig Maximilians University of Munich, Comprehensive Pneumology Center Munich (CPC-M), German Center for Lung Research (DZL), Munich, Germany.
⁸ Department of Pediatric Respiratory Medicine, Inselspital, University Children's Hospital of Bern, University of Bern, Bern, Switzerland.
⁹ Division of Pediatric Pneumology & Allergology, University Hospital Schleswig-Holstein-Campus Luebeck, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Luebeck, Germany.
¹⁰ Department of Paediatric Pneumology, Allergology and Neonatology, Hannover Medical School, Biomedical Research in Endstage and Obstructive Lung Disease (BREATH), German Center for Lung Research (DZL), Hannover, Germany.
¹¹ University Hospital Schleswig-Holstein-Campus Kiel, Department for Internal Medicine I, Airway Research Center North (ARCN), German Center for Lung Research (DZL), Kiel, Germany.

^# Contributed equally.

Abstract

Rationale: Asthma, obesity and physical activity (PA) are interrelated. However, longitudinal data with objective PA measures and direct assessment of body composition are still lacking.

Objective: To study the impact of symptom control on PA and body composition.

Methods: In a longitudinal cohort study of the German Center for Lung Research, we assessed the body composition of 233 asthma patients and 84 healthy controls using bioelectrical impedance analysis. PA (ie average daily steps and time of at least moderate activity, steps/min) was measured by accelerometry for one week. Asthma control was assessed by ACT score, ACQ-5 score and history of severe exacerbations. After two years of follow-up, we studied changes in physical activity and body composition in relation to asthma control.

Results: Patients with uncontrolled asthma had increased fat mass and decreased muscle mass compared to patients with controlled asthma or healthy controls. Both fat mass and muscle mass correlated better with asthma control than the body mass index (BMI). In multivariate regressions adjusted for age and sex, asthma control and physical activity were independent predictors of body composition (R² = 0.61, p < 0.001). Persistent uncontrolled asthma patients (n=64) had lower physical activity at both baseline (6614 steps/118 min) and follow-up (6195/115). Despite having stable BMI, they also had significant muscle loss (-1.2%, -0.88 kg, p<0.01) and fat accumulation (+1%, +1.1 kg, p<0.01). By contrast, temporarily uncontrolled or controlled asthma patients had higher physical activity at baseline (8670/156) and follow -up (9058/153) with almost unchanged body composition.

Conclusion: Persistent uncontrolled asthma is associated with sustained physical inactivity and adverse changes in body composition that might be overlooked by relying solely on BMI. Physical activity is an independent predictor of body composition and reliable long-term marker of symptom control.

Keywords: BMI; body composition; fat mass; muscle mass; physical activity; symptom control.

Grants and funding

The ALLIANCE infrastructure is provided by the participating sites of the German Centre for Lung Research (DZL) and associated study centers and hospitals. Direct coasts of the ALLIANCE Cohort are being paid by project grants from the German Federal Ministry of Education and Research (Bundesministerium für Bildung und Forschung, BMBF), grant number “82DZL001A4”.