Obesity and childhood asthma – mechanisms and manifestations

Abstract

Obesity is a chronic condition affecting children worldwide. However, the prevalence is higher in asthmatic children. Obese children most likely become obese adults. Understanding the clinical presentation of this subgroup is essential to their clinical management, now and in the future. This review highlights the most recent findings over the past 18 months in understanding the presentation and potential mechanisms of obesity in childhood asthma. Recent research suggests that inhaled corticosteroid efficacy is reduced in obese asthmatic children whereas ventilatory function and bronchoreactivity appear to be marginally affected. A paucity of studies describing airway inflammation and lung volume measurements in this subgroup limits their clinical characterization. Recent studies indicate metabolic abnormalities that typically manifest with excess adiposity may be associated with asthma, providing an interesting factor in the asthma-obesity link. The inception, persistence and composition of obesity prove important considerations for future studies. Highlighted is the need for more descriptive airway inflammation studies, lung volume assessments and longitudinal studies to better characterize the obese asthma phenotype in children and understand the pathogenesis from childhood to adulthood. Understanding the manifestations and mechanisms of obese asthma in childhood will help direct clinical management and targeted therapeutic interventions.