Childhood Overweight Increases Hospital Admission Rates for Asthma

Abstract

Carroll CL, Stoltz P, Raykov N, Smith SR, Zucker AR. Pediatrics. 2007;120(4):734–740 PURPOSE OF THE STUDY. To determine if childhood overweight increases the risk of hospitalization for asthma among children presenting to an emergency department with an asthma exacerbation. STUDY POPULATION. Children who were >2 years old and presented to the emergency department of a Connecticut children's hospital with an asthma exacerbation in 2005 were included in the study. METHODS. A retrospective chart review was completed. Children were classified as overweight (>95th weight-for-age percentile) or nonoverweight (≤95th weight-for-age percentile). Children with chronic medical conditions other than asthma were excluded. RESULTS. There were 884 visits for 813 children. Overall, 238 (27%) were admitted to the hospital, and 33 (4%) were admitted to the ICU. Overweight children (202 [23%]) were significantly more likely to be older (8.5± 4.4 vs 7.3 ± 4.3 years) and to inhabit an impoverished area (37% vs 28%). Overall, hospital admission was associated with higher clinical asthma score but not with age, gender, or poverty status. Despite similar asthma scores and therapeutic management in the emergency department, hospital and ICU admission was significantly more likely for overweight than nonoverweight children (odds ratio: 1.76 [95% confidence interval: 1.23–2.51]; P = .002). CONCLUSIONS. Overweight children with an acute episode of asthma seen in an emergency department are significantly more likely to be admitted than their nonoverweight counterparts. Overweight status clearly impacts asthma management and health in children. REVIEWER COMMENTS. The limitations of this study include its retrospective nature and the failure to use BMI because of lack of height data. However, the weight-for-age percentiles used in this study are most commonly used in practice. When children younger than 5 years, in which asthma diagnosis is difficult, are excluded, the conclusion still holds with overweight children ≥5 years old being significantly more likely to be admitted than nonoverweight children (33% vs 24%; P = .03). Whether the results reflect comorbidity, differences in lung mechanics, differences in response to therapy, more severe asthma, or socioeconomic or behavioral factors remains to be determined.