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The role of body mass index in acute exacerbations of chronic obstructive pulmonary disease
  1. C-L Tsai,
  2. C A Camargo, Jr
  1. Department of Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, and Department of Epidemiology, Harvard School of Public Health, Boston, Massachusetts, USA
  1. Correspondence to Dr C-L Tsai, EMNet Coordinating Center, Department of Emergency Medicine, Massachusetts General Hospital, 326 Cambridge Street, Suite 410, Boston, MA 02114, USA; cltsai{at}


Background: Low body mass index (BMI) is a strong prognostic marker in stable chronic obstructive pulmonary disease (COPD); however, little is known about its role in acute exacerbations of COPD.

Objectives: To determine the prevalence and determinants of low BMI in emergency department (ED) patients with acute exacerbations of COPD, and to examine whether low BMI was associated with more severe acute exacerbations, more intensive ED treatments and worse post-ED outcomes.

Methods: A secondary analysis was performed using data from a prospective multicentre cohort study involving 29 ED in the USA and Canada. Using a standard protocol, ED patients with acute exacerbations of COPD were interviewed and their charts reviewed. BMI was calculated using self-reported weight and height. Main outcome measures included hospital admission, post-ED relapse and ongoing exacerbation.

Results: 395 patients were enrolled. Their median age was 69 years (interquartile range 62–76); 52% were women. Thirteen per cent (95% CI 10% to 16%) were underweight, 37% normal weight, 27% overweight and 23% were obese. Current smoking was independently associated with underweight (OR 5.4, 95% CI 1.1 to 25.2). In the propensity-matched cohort, there were no significant differences in severity of exacerbation, treatments received in the ED, or short-term clinical outcomes, according to BMI.

Conclusions: Low BMI is not uncommon in patients with acute exacerbations of COPD, and current smoking is associated with low BMI in these patients. Unlike its role in stable COPD, BMI appears to have little impact on exacerbation severity, treatments received in the ED, and short-term clinical outcomes in acute exacerbations of COPD.

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  • Funding This study was supported by an unrestricted grant from Boehringer Ingelheim (Ridgefield, CT).

  • Competing interests Declared. CAC has received financial support (eg, research grants, consulting and lecture honoraria) from AstraZeneca (Wilmington, DE), Dey (Napa, CA), GlaxoSmithKline (Research Triangle Park, NC), Merck (Rahway, NJ), Novartis (East Hanover, NJ), Respironics (Cedar Grove, NJ) and Schering Plough (Kenilworth, NJ). C-LT declares no conflicts of interest.

  • Ethics approval The institutional review boards at each of the 29 participating hospitals approved the study.

  • Patient consent Obtained.

  • EMNet Steering Committee Edwin D Boudreaux, PhD; Carlos A Camargo, Jr, MD (Chair); Jonathan M Mansbach, MD; Steven Polevoi, MD; Michael S Radeos, MD, MPH; and Ashley F Sullivan, MPH, MS.

  • EMNet Coordinating Center Carlos A Camargo Jr, MD (Director); Kate Delaney; Lisa A Dubois; Adit A Ginde, MD; Andrea J Pelletier, MS, MPH; Ashley F Sullivan, MS, MPH; and Chu-Lin Tsai, MD, MPH—all at Massachusetts General Hospital, Boston, USA.

  • Principal Investigators at the 29 participating sites FC Baker III (Maine Medical Center, Portland, ME); MP Blanda (Summa Health System, Akron, OH); ED Boudreaux (Earl K Long Memorial Hospital, Baton Rouge, LA); BE Brenner (The Brooklyn Hospital Center, Brooklyn, NY); CA Camargo Jr (Massachusetts General Hospital, Boston, MA); RK Cydulka (MetroHealth Medical Center, Cleveland, OH); TJ Gaeta (New York Methodist Hospital, Brooklyn, NY); B Goldfeder (Shands Hospital at the University of Florida, Gainesville, FL); RJ Grant (Hartford Hospital, Hartford, CT); RO Gray (Hennepin County Medical Center, Minneapolis, MN); A Guttman (Sir Mortimer B Davis, Jewish General Hospital, Montreal, QC); LW Kreplick (Christ Hospital and Medical Center, Oak Lawn, IL); DS Mackey (Lethbridge Regional Hospital, Lethbridge, AB); A Mangione (Albert Einstein Medical Center, Philadelphia, PA); J Peters (University of Texas Health Sciences Center at San Antonio, San Antonio, TX); MS Radeos (Lincoln Medical Center, Bronx, NY); PL Rice (Brigham and Women’s Hospital, Boston, MA); BH Rowe (University of Alberta Hospital, Edmonton, AB); M Sama (St Joseph Mercy Hospital, Ann Arbor, MI); D Schreiber (Stanford University Medical Center, Stanford, CA); NI Shapiro (Beth Israel Deaconess Medical Center, Boston, MA); PC Shukla (University of Texas Southwestern Medical Center, Dallas, TX); D Sinclair (Queen Elizabeth II Health Science Centre (Halifax, NS); H Smithline (Baystate Medical Center, Springfield, MA); PE Sokolove (UC Davis Medical Center, Sacramento, CA); M Steffens (Palmetto Richland Memorial Hospital, Columbia, SC); CA Terregino (Cooper Hospital/University Medical Center, Camden, NJ); A Travers (Royal Alexandria Hospital, Edmonton, AB) and EJ Weber (UCSF Medical Center, San Francisco, CA).

  • Provenance and peer review Not commissioned; externally peer reviewed.