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High BMI and COPD Outcomes in Alpha-1 Antitrypsin Deficiency
Michael A Campos1, Leonard Riley2, Jorge Lascano3
1Department of Medicine, Division of Pulmonary, Critical Care and Sleep Medicine, University of Miami, Miami, FL.
CHEST Pulmonary
|August 4, 2026
Summary
High BMI is common in alpha-1 antitrypsin deficiency COPD (AATD-COPD) and worsens quality of life, but does not affect survival. Changes in BMI over time impact health-related quality of life.
Area of Science:
- Pulmonology
- Metabolic Health
- Genetics
Background:
- Elevated Body Mass Index (BMI) is known to impact morbidity in Chronic Obstructive Pulmonary Disease (COPD) patients.
- However, the specific impact of high BMI on COPD patients with alpha-1 antitrypsin deficiency (AATD-COPD) remains understudied.
Purpose of the Study:
- To determine the prevalence of high BMI in AATD-COPD patients.
- To investigate the clinical impact of high BMI on symptoms, exacerbations, health-related quality of life (HRQoL), and survival in this population.
Main Methods:
- A cohort of 646 AATD-COPD patients was followed for 2 years, completing clinical and HRQoL assessments.
- Patients were categorized by baseline BMI (underweight, normal, overweight, obese, morbidly obese) to compare outcomes.
- The relationship between BMI changes over time and HRQoL was also analyzed.
Main Results:
- Over 60% of AATD-COPD patients had a high BMI (overweight, obese, or morbidly obese).
- High BMI was significantly associated with worse HRQoL scores (SGRQ, SF-36 physical composite) and increased emergency visits/hospitalizations.
- Despite increased morbidity, high BMI did not significantly impact 9-year survival rates.
- Worsening BMI over time correlated with decreased HRQoL, while improvement in BMI led to better HRQoL.
Conclusions:
- High BMI is prevalent in AATD-COPD and linked to increased comorbidity and poorer HRQoL.
- BMI management may be important for improving HRQoL in AATD-COPD patients.
- BMI status does not appear to influence long-term survival in this cohort.
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