Format

Send to

Choose Destination
J Allergy Clin Immunol. 2018 Apr;141(4):1459-1467.e2. doi: 10.1016/j.jaci.2017.09.043. Epub 2017 Dec 19.

Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids.

Author information

1
Department of Pediatrics, Duke University School of Medicine, Durham, NC. Electronic address: jason.lang@duke.edu.
2
Department of Pediatrics, Emory University, Atlanta, Ga.
3
Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pa.
4
Cincinnati Children's Hospital and Medical Center, Cincinnati, Ohio.
5
Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
6
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
7
Arizona Respiratory Center, University of Arizona, Tuscon, Ariz.
8
Washington University School of Medicine, St Louis, Mo.
9
Kaiser Permanente Medical Center, University of California-San Diego, San Diego, Calif.
10
Boston Children's Hospital, Harvard Medical School, Boston, Mass.
11
Children's Memorial Hospital, Chicago, Ill.
12
University of Pittsburgh School of Medicine, Pittsburgh, Pittsburgh, Pa.
13
University of California-San Francisco, San Francisco, Calif.
14
National Jewish Health, Denver, Colo.
15
University of New Mexico, Albuquerque, NM.
16
Department of Pediatrics, Duke University School of Medicine, Durham, NC.
17
Children's Hospital Colorado, The Breathing Institute, and University of Colorado School of Medicine, Aurora, Colo.

Abstract

BACKGROUND:

Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults.

OBJECTIVE:

We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children.

METHODS:

This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups.

RESULTS:

Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P = .020) and exacerbations (1.4 vs 0.8, P = .009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P = .44; short-term ICS: 61.8 vs 52.9 days, P = .46; as-needed ICS: 53.3 vs 47.3 days, P = .53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P = .10; short-term ICS: 1.1 vs 0.8 days, P = .25; as-needed ICS: 1.0 vs 1.1, P = .72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P = .004) and exacerbations (1.4 vs 0.6, P = .006), while similar protective ICS effects were less apparent among NW.

CONCLUSIONS:

In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.

KEYWORDS:

Asthma; children; exacerbation; infants; obesity; overweight

PMID:
29273557
DOI:
10.1016/j.jaci.2017.09.043

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center