Childhood obesity in pediatric patients with difficult-to-control asthma in a tertiary pediatric subspecialty clinic

Abstract

Identifying clinical features associated with difficult-to-control asthma will help address overall control and more-effective asthma management. To evaluate our clinical observation that the proportion of patients who are overweight or obese is significantly higher in patients with difficult-to-control asthma than in patients with well-controlled asthma. This was a retrospective chart review of 400 patients, ages 5 to 18 years. Cases (n = 200) were identified as 100 subjects with difficult-to-control asthma and an inhaled corticosteroid dose of ≥1000 μg/day and 100 subjects with well-controlled asthma and an inhaled corticosteroid dose of ≤500 μg/day. The control group included 200 subjects without asthma. Multivariable logistic regression models were used to assess the relationships between asthma status and weight status, age, race, and sex. The mean body mass index percentile (± standard deviation at 95% confidence interval) was significantly higher in the difficult-to-control asthma group versus the well-controlled asthma group versus the control group (74.66 ± 28.19 versus 54.25 ± 29.92 versus 55.19 ± 32.54; p < 0.001). Thirty-six percent of the difficult-to-control patients with asthma were obese (versus 6% of the patients with well-controlled asthma [p < 0.001] versus 13% of patients without asthma [p = 0.002]), and 47% normal weight (versus 79% of the patients with well-controlled asthma versus 75% of patients without asthma; p < 0.001). The mean age and the proportion of African Americans in the difficult-to-control asthma group were significantly higher than in the well-controlled asthma group and in the control group (p < 0.001). The results of this study demonstrated a significant association between severe persistent difficult-to-control asthma and obesity, age, and race. Patients who are obese and have difficult-to-control asthma need treatment approaches that address both asthma control and weight management.