Obese Asthmatic Children Research Articles

Atopic disease and body mass index

Background Obesity and atopy are two increasingly important population health issues. Excess weight and obesity are potential risk factors for atopy (specifically asthma). Objective and methods To determine the body mass index (BMI) in children with atopic disease compared with nonatopic children, and to determine whether obesity is associated to more severe disease.Children aged 5 to 16 years with diagnosed atopic disease that attended the Ambulatory Hospital Center where eligible as cases. Children aged 5 to 16 years without atopic disease from a school in the same geographic area were used as controls. Results A total of 228 children where included in the analysis: 112 children with atopy (75.9 % asthma, 21.4% rhinitis and 2.7 % eczema) and 116 children without atopy. The median age was 10.5 and 10.3 years for the atopic and non-atopic children, respectively. The prevalence of overweight or obese subjects was significantly greater in the atopic group (44.6 % vs 31.9 %, p < 0.05). The obese asthmatic children had a significantly higher prevalence of sleep disturbances due to wheezing in the last 12 months (45.5% vs 15.9 %, p < 0.05). They also reported dry cough at night more often (50 % vs 28.6 %, p = 0.07), and a higher number of wheezing attacks in the past 12 months (72.7% vs 50.8 %, p = 0.074), than the non-obese asthmatic children. Most of the obese atopic children were already overweight or obese at the time of the diagnosis (66.6 %). None of the associations were significantly different for boys or girls. Discussion There is some evidence of an association between excess body weight or obesity and atopy - particularly asthma.

Asthma and Insulin Resistance in Morbidly Obese Children and Adolescents

Background. Obesity is well recognized as a state of increased insulin resistance and has been implicated as a significant risk factor for both asthma prevalence and asthma severity in children and adolescents. However, little is known about the specific factors that relate asthma and obesity. Recently, the pro-inflammatory state in obesity and its association with insulin resistance have been recognized. We hypothesize that the effect of morbid obesity on asthma is related to insulin resistance. Methods. The patient cohort in the obesity management program at the Children's Hospital of Wisconsin was retrospectively reviewed. Variables were collected from the program data base and chart review was done for missing variables. Patients were considered to have asthma if the evaluating physician confirmed the diagnosis through history and/or the patient had been on inhaled corticosteroids. Insulin resistance (IR) was calculated using a homeostasis model assessment (HOMA). Multivariate logistic regression was performed to identify variables that were significantly related to the odds of having asthma. Results. Of the 415 patients included in the study, 146 (35%) were asthmatic and 269 (65%) were non-asthmatic. The asthma (AG) and non-asthma (NAG) groups were similar with respect to mean age (11.3 vs. 11.5 years), gender (45% vs. 43% males), mean body mass index (BMI) (36.4 vs. 34.9), and exposure to smoking (43% vs. 42%). Fhx of asthma was significantly higher in AG (71%) compared to NAG (40%). IR level ± SD was 8.5 ± 9.7 in AG compared to 5.3 ± 6.7 in NAG (p < 0.0001). Multivariate regression analysis found the following variables to be associated with having asthma: younger age (p < 0.05), smoking exposure (p < 0.05), positive Fhx of asthma (p < 0.0001, odds ratio of 3.1), and IR (p < 0.0001, odds ratio of 4.1). Conclusion. Morbidly obese asthma patients have a higher degree of insulin resistance compared to morbidly obese non-asthma patients. We speculate that the pro-inflammatory state of insulin resistance may contribute to the pathogenesis of asthma in obese patients. Future prospective studies should address insulin resistance as a possible risk factor for asthma in obese children and adolescents.

Ability to Control Persistent Asthma in Obese Versus Non-Obese Children Enrolled in an Asthma-Specific Disease Management Program (Breathmobile)

To determine if asthma control was more difficult to achieve in obese versus non-obese asthmatic children, retrospective analysis was performed on obese and non-obese Los Angeles inner-city children (2 to 18 years of age) with persistent asthma. No difference in time required to achieve control of asthma, ability to maintain control of asthma, baseline pulmonary functions, and number of controllers prescribed was found between the two groups. We conclude that in a Los Angeles inner-city pediatric population, obesity is not a factor in the ability to control asthma.