Obesity, asthma and contraception

A review of this week's medical research. By GP Dr Louise Newson

Central obesity was found to be significantly associated with voiding dysfunction in men (Photograph: Ian Hooton/SPL)
Central obesity was found to be significantly associated with voiding dysfunction in men (Photograph: Ian Hooton/SPL)

Central obesity and lower urinary tract symptoms

BJU Int 2012; 110(4): 540-5

Metabolic syndrome is more common in obese people. It is known that men with metabolic syndrome have an increased risk of cardiovascular disease and sexual dysfunction.

More recent studies have shown that there seems to be a negative association between metabolic syndrome and voiding function.

This study was undertaken to determine if central obesity is associated with and predictive of the severity of voiding dysfunction. Men aged over 40 years with moderate or severe lower urinary tract symptoms (LUTS) with no previous treatment were included for study.

The men were divided into three groups, depending on their waist circumference.

The results showed that waist circumference was significantly and positively associated with prostate volume, serum PSA and international prostate symptom score. In view of these results, it may be that we should ask more of our obese male patients about any urinary symptoms they may have.

Inhaled glucocorticoids in childhood and adult height

N Engl J Med 2012; doi: 10.1056/NEJMoa1203229

It is well established from previous studies that using inhaled glucocorticoids for persistent asthma can cause temporary reduction in growth velocity in prepubertal children. However, this is not thought to make any difference to an individual's height in adulthood.

In this study, children aged five to 13 years were measured before and after receiving either 400 microgram budesonide, 16mg nedocromil or placebo daily for four to six years.

The results showed that the mean adult height was 1.2cm lower in the budesonide group than in the placebo group and 0.2cm lower in the nedocromil group than in the placebo group. These results contradict those of other studies that have been carried out in this area. Perhaps we should be warning patients with asthma about this.

Tiotropium can improve poorly controlled asthma

N Engl J Med 2012; 10.1056/NEJMoa1208606

Some patients who have asthma continue to experience frequent exacerbations and persistent airflow obstruction, despite treatment with inhaled glucocorticoids and long-acting beta-agonists (LABAs). This study involved two replicate, randomised, controlled trials which looked at more than 900 patients with asthma who were receiving inhaled glucocorticoids and LABAs. The effect of adding either tiotropium or placebo was compared over a 48-week period.

The results showed that the addition of tiotropium significantly increased the time to the first severe exacerbation and provided modest sustained bronchodilation.

Walking speed and mortality risk in elderly patients

Arch Intern Med 2012; 172(15): 1162-8

Walking speed, used as a measure of frailty, could identify which elderly adults are most at risk of the adverse effects of hypertension.

This study involved measuring walking speed in more than 2,300 people aged over 65 years. The results found that the association between BP and mortality varied by the individual's walking speed.

Among faster walkers, those with elevated systolic BP had a greater adjusted risk of mortality, compared with those without. Among slower walkers, neither elevated systolic nor elevated diastolic BP was associated with mortality.

Walking speed could therefore be a simple measure that we might use in the future to identify elderly adults who are most at risk for adverse outcomes related to high BP.

Infection after caesarean section in obese women

BJOG 2012; DOI: 10.1111/j.1471-0528.2012.03452.x

Caesarean rates in the UK are rising steadily and about a quarter of all deliveries are now caesarean sections. Obesity rates are also rising in the UK.

In this study, more than 4,000 women who had a caesarean section were followed up with regard to infections. There was a surgical site infection rate of nearly 10%. Most of these infections were superficial, affecting the skin and surface layers.

After adjustment for other patient and operation risk factors, the study found that obesity and age under 20 years were both associated with a higher risk of developing an infection.

Compared with women with a normal BMI, obese women were 2.4 times more likely to develop an infection.

It is important that infections are recognised early and treated promptly, because infections following caesarean sections can seriously affect a woman's quality of life at a time when she is recovering from an operation and has a newborn to look after.

Should pharmacists supply oral contraception?

J Fam Plann Reprod Health Care 2012; doi: 10.1136/jfprhc-2012-100304

In the UK, half of all pregnancies are unplanned and half of all teenage pregnancies result in a termination.

A contraception service was set up in south London, which has the highest teenage conception rates in the capital. Qualified pharmacists supplied oral contraception using a patient group direction.

About half of the consultations evaluated in this study took place after the patient had received emergency contraception. The COC was most commonly given, especially to first-time users of contraception. Most of the consultations were with women aged under 30 years and most of the women were very satisfied with the service provided by the pharmacists. Perhaps this should be extended to other regions.

  • Dr Newson is a GP in the West Midlands and a member of our team who regularly review the journals.

These further action points may allow you to earn more credits by increasing the time spent and the impact achieved.

  • Consider holding a meeting with a local urologist to discuss the clinical implications of the study showing an association between LUTS and central obesity.
  • Perform a search of your childhood asthma patients who are receiving inhaled steroids. Determine the proportion of children who have regular height measurements documented in their notes.
  • Determine the infection rate following caesarean sections in your patients over the past year. See if there is a difference in the rate in women who are obese compared with those who are not.

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