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Obesity and Its Impact on Lung Function: A Comprehensive Analysis, Slides of Pneumology

An in-depth examination of obesity as a global health issue, its prevalence, and the associated risks, particularly in relation to lung function. It covers various aspects such as obesity classifications, body composition, pulmonary function, gas exchange, and control of breathing. The document also discusses the use of non-invasive ventilation in managing obesity-related respiratory conditions.

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2011/2012

Uploaded on 12/22/2012

anna.joe
anna.joe 🇮🇳

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Obesity & The Lung
Obesity constitutes a significant health problem worldwide. In the United States, it is
estimated that more than half of all adults are overweight or obese. It is an increasing
problem in developing countries.
Its prevalence continues to increase. In the U.S, an increase of more than 25% over the
last three decades was seen. The number of individuals with severe obesity has tripled
It is a leading cause of preventable death in the United States, second only to cigarette
smoking
Morbidity and mortality associated with obesity increase with increasing BMI.
Intra-abdominal fat distribution is also an independent risk for cardiovascular disease
and mortality. Upper body or central fat distribution has a greater effect on pulmonary
function than lower body fat distribution. Furthermore, abdominal fat distribution is
more often associated with sleep-disordered breathing
World Health Organization and the National Institutes of Health have classified obesity
as follows: based on the BMI
18.5- 24.9 kg/m2 normal
25.0 -29.9 kg/m2 overweight
30.0 -34.9 kg/m2 Grade 1 obesity.
35.0-39.9 kg/m2 Grade.2 obesity
>40.0 kg/m2 Grade 3(morbid) obesity
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Obesity & The Lung• Obesity constitutes a significant health problem worldwide. In the United States, it isestimated that more than half of all adults are overweight or obese. It is an increasingproblem in developing countries.• Its prevalence continues to increase. In the U.S, an increase of more than 25% over thelast three decades was seen. The number of individuals with severe obesity has tripled• It is a leading cause of preventable death in the United States, second only to cigarettesmoking• Morbidity and mortality associated with obesity increase with increasing BMI.• Intra-abdominal fat distribution is also an independent risk for cardiovascular diseaseand mortality. Upper body or central fat distribution has a greater effect on pulmonaryfunction than lower body fat distribution. Furthermore, abdominal fat distribution ismore often associated with sleep-disordered breathing• World Health Organization and the National Institutes of Health have classified obesityas follows: based on the BMI– 18.5- 24.9 kg/m2 normal– 25.0 -29.9 kg/m2 overweight– 30.0 -34.9 kg/m2 Grade 1 obesity.– 35.0-39.9 kg/m2 Grade.2 obesity– >40.0 kg/m2 Grade 3(morbid) obesity

Body Composition in Obesity Parameter Normal^ Mild Obesity^

Severe Obesity BMI(kg/m2 )^23

Body fat (%)^22

Body weight (kg)^65

Fat-free mass (kg)^51

Body cell mass (kg)^27

Total body water (L)^38

REE (watts)^68

86 96 Docsity.com

-^ Spirometry in individuals with obesity hypoventilation syndrome (OHS)usually reveals a more severe restrictive pattern with reductions in–^ TLC, VC,–^ MVV, and–^ peak inspiratory flow rate•^ This appears to be related to weakness of the respiratory muscles.•^ The ERV may be reduced to 35% of predicted and the FVC to 60% ofpredicted•^ The adverse effects of obesity on pulmonary function cannot be entirelyexplained by the absolute load of adipose tissue on the chest wall becausesimilar degrees of obesity in simple obesity and OHS result in differentpatterns of lung volume changes .•^ The single-breath diffusion capacity is usually normal or increased insimple obesity and slightly reduced in OHS

-^ OHS>Obesity generally lowers compliance of the lung, chest wall, and totalrespiratory system. –^ due to weight pressing on the thorax and abdomen thereby imposing an elastic load.–^ threshold-type load on the chest wall in which pleural pressure must be lowered toa sufficient degree before inspiratory flow can begin.•^ Specific airway conductance may be reduced to 50% to 70% of normal.•^ FEV1 /FVC ratio is normal^ –^ increased airway resistance in obesity appears to lie in lung tissue and smallairways–^ Impediment to breathing in obesity results from a two- to threefold increase inintra-abdominal pressure•^ The transition from upright to the supine position reduces lung volume due toincreased intra-abdominal pressure & promotes expiratory flow limitation duringtidal breathing •^ The work of breathing is 60% higher in simple obesity and may be as much as250% higher in OHS with an Increase in the energy cost of breathing; the oxygencost of breathing at rest •^ This places obese patients at risk for respiratory failure during conditionscharacterized by increased ventilatory demands such as an intercurrent illness . Docsity.com

NIV in obesity• CPAP for patients with OSA.• BiPaP for– Obese patients who experience nocturnal or nocturnal and daytime hypercapnia.– OSA patients not tolerating high CPAP pressures required– OSA patients having obstruction despite high CPAP pressures.• BiPaP has been used successfully to treat atelectasis after gastroplasty• Positive-pressure ventilation– improves sleep quality, (CHEST 2001; 119:1102–1107) – corrects hypercapnia, and– improves daytime oxygenation