Can the morbidly obese asthmatic child be well controlled? The Breathmobile program

Abstract

The obese asthmatic is thought to disproportionally experience greater severity, morbidity, increased exacerbations, and reduced inhaled corticosteroid responsiveness. We have previously reported that care provided by a community-based healthcare delivery system, the Breathmobile, results in improved asthma control, and reduced morbidity. We hypothesized that this system of care could provide similar outcomes for the morbidly obese compared to the normal weight asthmatic child. This was a retrospective analysis of 1,204 asthmatic children, ages 3 to 18 years, who enrolled in the BreathmobileTM Program during years 2003 to 2012. Body mass index (BMI) percentiles determined previously established weight categories from normal weight to morbidly obese. Analysis was performed for time to achieve well controlled asthma, morbidity reduction comparing post vs. previous year, and probability of exercise limitation from baseline to the last visit. Of the 1,204 children, 90.3% were Hispanic with a mean age of 7.7 years (SD 3.5 years). Over 50% had a BMI greater than normal, with 22.1% overweight, 24.4% obese, and 8.3% morbidly obese. Approximately 80% achieved well-controlled asthma by the third visit, except for the morbidly obese when visit interval exceeded 90 days. Reduced probability of greater than 50% was noted for emergency visits, hospitalizations, school absenteeism, and exercise limitation to a similar extent across BMI categories, without significant improvement in BMI status. We have shown that well-controlled asthma associated with reduced morbidity is achievable in the morbidly obese similar to normal weight asthmatics, assuming adequate follow-up, as demonstrated by the Breathmobile program.