Mass General Brigham researchers in Boston have pinpointed a critical gap in the management of asthma among obese patients. Their study, “Asthma Management in Obesity: Identifying the Gap Between Evidence and Practice,” noted that despite well-established evidence that weight loss can significantly improve asthma outcomes, the integration of weight management strategies into asthma care remains limited. The study was published in The Journal of Allergy and Clinical Immunology.
According to the study’s authors, obesity is a known risk factor for asthma, and guidelines recommend incorporating weight loss into asthma management plans. However, there is limited guidance on how to translate these recommendations into clinical practice, and studies on provider practices are scarce.
“There are few guidelines such as [Global Initiative for Asthma (GINA)] that recommend that obesity management or weight loss be discussed in the context of asthma,” Oluwatobi Olayiwola, MD, second-year fellow in the division of allergy and clinical immunology at Brigham and Women’s Hospital and research associate with the Immune Tolerance Network, told Healio. “But there’s really not a lot of guidance on how to do it,”
According to GINA guidelines, patients with obesity and asthma should strive to lose between 5% and 10% of their weight.
For the study, researchers analyzed outpatient notes from primary care, allergy/immunology and pulmonary providers for patients with comorbid asthma and obesity between January 2020 and September 2023. Using Microsoft Azure OpenAI’s GPT-40, they assessed whether the notes discussed asthma management and weight management strategies.
Of the 86,604 patient encounters analyzed, 96.1% discussed asthma management. However, only 8.6% included weight management in the asthma plan. Weight management was more frequently discussed in subspecialty encounters (11.4%) compared to primary care (7.4%). Dr. Olayiwola said pulmonary specialists receive high marks for linking obesity management to asthma care. However, allergy and immunology clinicians are not incorporating obesity management into asthma care.
“Yet, we do know that weight loss impacts your asthma symptoms and severity,” Olayiwola said.”
Researchers reported that the most frequently discussed weight management strategies were exercise (77.5%), diet (64.9%) and weight loss education (24.7%). The mean age of patients was 54.3 years, with 74.9% female, 74.8% white and a mean BMI of 36.3 (obese).
The results suggest that weight management is significantly lacking in routine asthma care for obese patients, despite evidence and guidelines supporting its benefits, researchers said. The findings underscore the need for future interventions to improve care for this at-risk population and provide a foundation for developing strategies to bridge the gap between evidence and practice.
