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J Allergy Clin Immunol Pract. 2019 Mar;7(3):954-961.e6. doi: 10.1016/j.jaip.2018.09.033. Epub 2018 Oct 9.

Does Obesity Increase Respiratory Tract Infections in Patients with Asthma?

Author information

1
Department of Pediatrics, Duke University, Durham, NC. Electronic address: monica.tang@duke.edu.
2
Department of Epidemiology, Johns Hopkins University, Baltimore, Md.
3
Department of Medicine, Duke University, Durham, NC.
4
Department of Medicine, Johns Hopkins University, Baltimore, Md.
5
Department of Medicine, University of Vermont, Burlington, Vt.
6
Department of Medicine, Wake Forest University, Winston-Salem, NC.
7
Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
8
Department of Medicine, Northwestern University, Chicago, Ill.
9
Department of Pediatrics, University of Virginia, Charlottesville, Va.
10
Department of Pediatrics, Duke University, Durham, NC.

Abstract

BACKGROUND:

Because respiratory tract infections (RTIs) precede most exacerbations, a better understanding of the risk factors of RTIs and RTI-associated exacerbations in patients with asthma is a pressing public health need. Obesity in patients with asthma is associated with worse asthma control and higher asthma-associated health care utilization, but its effect on RTI risk is unknown.

OBJECTIVE:

We aimed to study the association of body mass index (BMI) classification on the risk of self-reported RTIs and related asthma morbidity among adults and children with asthma.

METHODS:

This post hoc analysis of 5 large asthma trials involving 747 children and 1287 adults compared BMI classification, defined as lean, overweight, and obese based on age-appropriate BMI and BMI-percentile conventions. The primary outcome was rate of visits with RTIs. Secondary asthma outcomes included upper respiratory infection (URI) severity, systemic steroid use, and health care contact.

RESULTS:

Children had 1.4 times the rate of RTI compared with adults (95% confidence interval 1.27-1.56). In all participants, BMI classification did not affect the rate of visits with RTI. In children, BMI classification did not affect URI severity, all-cause asthma events, or RTI-associated asthma events. However, in adults, higher BMI classification was associated with an increase in moderate/severe URI (P = .02). Adults with higher BMI classification also had increased rates of all-cause and RTI-associated asthma exacerbations requiring systemic steroids and health care contact.

CONCLUSIONS:

BMI classification was not associated with an increased risk of RTIs in children or adults. In adults only, obesity was associated with increased URI severity and all-cause and RTI-associated asthma morbidity.

KEYWORDS:

Asthma; Obesity; Respiratory tract infections

PMID:
30312805
DOI:
10.1016/j.jaip.2018.09.033

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