Obese Asthmatic Children Research Articles

WEIGHT LOSS FOR CHILDREN AND ADULTS WITH OBESITY AND ASTHMA: SYSTEMATIC REVIEW

Introduction: Asthma, a widespread respiratory condition affecting 339 million people globally, is closely associated with obesity, which is on the rise worldwide. This review examines the impact of weight loss on asthma in individuals dealing with obesity, drawing from randomized controlled trials in both children and adults. Method: This study followed the 2020 PRISMA guidelines to ensure research alignment with necessary standards for accuracy. Articles were retrieved from databases including PubMed database in October 2023. Result: The search strategy produced a total of 14 results. Upon reviewing the titles and abstracts, we identified 8 papers that met the criteria for inclusion. Initially, 8 articles were excluded from consideration as they were written in a review format. After a thorough evaluation of the full-text papers, we ultimately included five papers in the final analysis, consisting of prospective analysis, cross-sectional study, retrospective analysis, experimental study, and secondary analysis to a randomized control trial. Conclusion: Diet significantly impacts respiratory health in non-overweight/non-obese children, while obesity is linked to severe asthma exacerbations, emphasizing the need for further research and public health campaigns. Short-term dietary interventions in obese asthmatic children successfully reduce calorie intake and sugar consumption, but improvements in other dietary aspects may take time, and physical activity plays a crucial role in weight loss, especially in those with lower baseline lung function. Adding exercise to weight loss interventions in obese adults with asthma yields multiple benefits, including reduced depression symptoms and improved asthma control, and moderate weight loss can delay dynamic hyperinflation, enhancing quality of life and clinical control, underscoring the significance of lifestyle interventions in managing asthma across different age groups.

Intergenic interactions of <i>ADRB2</i>, <i>ADRB3</i>, <i>FABP2</i> and <i>PPARG</i> genes in children with asthma associated with obesity

Introduction. The constant increase in the prevalence of bronchial asthma in children and adolescents raises concerns about a parallel increase in obesity-related asthma and suggests that obesity alters asthma towards a phenotype that is more difficult to control. The development of multifactorial diseases (asthma and obesity) is based on complex intergenic interactions that must be taken into account when predicting the risk of developing an unfavorable course of the pathological process.Aim. To study the contribution of polymorphic variants of the metabolism genes rs1042713 (Arg16Gly) and rs1042714 (Gln27Glu) of the β2-adrenoceptor gene (ADRB2), rs4994 Trp64Arg of the β3-adrenoceptor gene (ADRB3), rs1801282 of the PPARG gene, rs1799883 Ala54Thr of the FABP2 gene using Multifactor Dimensionality Reduction (MDR) in patients with asthma and obesity to identify significant intergenic interactions.Materials and methods. 161 children withasthma were examined, including 59 patients with obesity of 1-3 degrees. The examination included general clinical, laboratory, and functional methods. The level of asthma control was determined according to the GINA criteria (2018). The study of gene polymorphisms was carried out by real-time polymerase chain reaction using sets of “Metabolism” (Research and Production Company “Litekh”, Moscow) on the CFX-96 Biorat device (USA).Results. When comparing groups of children with asthma associated with obesity, a significant model of the interaction of the ADRB3 and FABP2 genes was determined. This two-locus model of intergenic interaction. According to this model, children with bronchial asthma with the following genotypes have an increased risk of obesity: Trp64Arg ADRΒ3 and Ala54Thr FABP2; Trp64Arg ADRΒ3 and Thr 54Thr FABP2; Trp64 Trp ADRΒ3 and Ala54Thr FABP2; Trp64 Trp ADRΒ3 and Thr 54Thr FABP2. In patients with AD associated with obesity and lack of disease control, we identified another statistically significant two-locus model of the interaction of the rs1042713 genes of the ADRB2 gene and PPARG. According to this model, children with the following genotypes have an increased risk of lack of disease control in patients with obesity-associated asthma: Arg16Gly ADRB2 and Pro12Ala PPARG; Arg16Gly ADRB2 and Ala12Ala PPARG; Gly16Gly ADRB2 and Pro12Ala PPARG; Gly16Gly ADRB2 and Ala12Ala PPARG.Conclusion. The obtained results of the analysis of intergenic interactions indicate that a key role in the formation of predisposition to obesity in asthma patients belongs to the association of polymorphic variants of the ADRB3 (rs4994) and FABP2 (rs1799883) genes, and the risk of uncontrolled asthma in obese children are patients with a combination of polymorphisms rs1042713 of the ADRB2 gene and rs1801282 of the PPARG gene, as evidenced by revealed two-locus models of intergenic interactions that determine the predisposition to obesity in children with asthma and affect the course of the disease. Identification of genetic predictors of both asthma and obesity is important for identifying individuals with an increased risk of developing this disease, and requires further study in the search for probable cause-and-effect relationships and the creation of personalized programs depending on polymorphic gene variants.

Cytokines Profile and Lung Function in Children with Obesity and Asthma: A Case Control Study.

The existence of common inflammatory biomarkers linking obesity and asthma in children has been hypothesized. Nevertheless, laboratory and clinical characteristics of children with obesity and asthma are still poorly defined. The primary aim of the present study is to investigate the lung function and the cytokine profile, in children with obesity and asthma. In this prospective, cross-sectional pilot study, pulmonary function tests, biochemical parameters, and serum cytokines levels were compared in three groups of 28 children each, matched for age and sex. Obese children showed normal forced spirometry values except an increased distal airway resistance in subjects with obesity and no asthma. Both groups including obese children showed higher leptin and IL-10 levels and lower adiponectin and TNF-alpha levels compared to children with no obesity and asthma. IL-33 and TGF-beta1 levels were higher in children with obesity and asthma vs. children with normal weight and asthma. Finally, IL-6 was undetectable in approximately 70% of obese children with no asthma, in 57% obese asthmatic children and in 100% of children with normal-weight and asthma. Children with obesity and asthma show the most striking cytokine profile, suggesting a pro-inflammatory role of fat mass in asthma development.

AIRWAY INFLAMMATION IS ASSOCIATED WITH PULMONARY FUNCTION IN OBESE ASTHMATIC INDIAN CHILDREN

Objective: Obesity and asthma are related conditions, however, the underlying mechanism between the two is not understood. This study aims to determine the correlations between fractional exhaled nitric oxide (FeNO) and spirometry parameters in obese asthmatic children. Design and method: In this study, 47 overweight/ obese asthmatic children (physician-diagnosed children with partly/ uncontrolled asthma as per Global Initiative forAsthma guidelines) were recruited from Pediatrics Chest Clinic, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. The measured height and weight were used to calculate BMI. BMI derived was categorized by using Z score tables of WHO-BMI for age standards for boys and girls between 5 and 19 years. Children were assessed using measurement of FeNO(NIOX1; Aerocrine, Solna, Sweden), and spirometry parameters were assessed using Superspiro MK2 Micro Medical Ltd, UK. Correlation between FeNO levels and spirometry parameters were investigated using Spearman’s correlation coefficients. Results: The mean ± SDage was 11.3 ± 2.5 years (males, n = 37), BMI = 24.91 ± 7.05 Kg/m2 and median (interquartile range) FeNO levels were 22.0 (17.0, 65.0) ppb. The mean ± SD predicted forced expiratory flow (FEF25–75) predicted was 83.5 ± 16.3%. The mean age of onset of asthma was 6.3 years. Twenty-four children had partly controlled asthma and 23 children had uncontrolled asthma. FeNO was significantly and inversely correlated with predicted FEF25-75 (r = -0.378, p < 0.001). Conclusions: FeNO an easily measurable indicator of airway inflammation in combination with lung function may prove a useful tool in the asthma assessment and management in obese Indian asthmatic children.

HEALTH-RELATED QUALITY OF LIFE, LUNG FUNCTION AND ASTHMA CONTROL IN OBESE ASTHMATIC INDIAN CHILDREN

Objective: Obesity is a major risk factor for asthma in children. Obese children have an increased risk of asthma; have more frequent and severe exacerbations, decreased lung function, and poor quality of life. However, the relationship between obesity, lung function, and asthma control remains unclear in obese asthmatic Indian children. Therefore, we examined the relationship of body mass index (BMI) with lung function, asthma control, and quality of life in obese asthmatic children. Design and method: Forty-seven children (8–15 years) with asthma according to Global Initiative for Asthma (GINA) guidelines were enrolled in the study from the Pediatric Chest Clinic of All India Institute of Medical Sciences, New Delhi, India. Weight was recorded to the nearest 0.1 kg and height was measured using a stadiometer nearest to 0.1 cm. The measurements of height and weight were used to calculate BMI. BMI derived was categorized by using Z score tables of WHO-BMI for age standards for boys and girls between 5 and 19 years. Lung function was assessed using spirometry parameters (Super spiro MK2 Micro Medical Ltd, UK), HRQoL was assessed using Juniper’s Pediatric Asthma Quality of Life Questionnaire (PAQLQ), and level of asthma control was assessed by Juniper’s Asthma control questionnaire (ACQ). ACQ score ranges from 0 (well controlled) to 6 (extremely poorly controlled). Spearman’s rank correlation analysis was performed to study the relationship between BMI, lung function parameters, PAQLQ score, and asthma control score Results: Obese children had mean (SD) age of 10.7 (2.5) years, BMI = 25.9 ± 7.5 kg/m2, forced expiratory volume-1 second (FEV1)/ forced vital capacity (FVC) was 82.8 ± 10.7%, ACQ score of 1.5 (0.8), and PAQLQ score of 5.5 (1.1).BMI was significantly directly correlated with ACQ score (r = 0.610, p < 0.001), and inversely correlated with predicted FEV1/FVC (r = -0.537, p = 0.002) and PAQLQ score (r = -0.625, p < 0.002). Conclusions: In obese asthmatic children, obesity is associated with a reduction in lung function and poor asthma control, and quality of life. Early weight-loss interventions could play role in preventing obesity and related pulmonary function impairment in asthmatic children.

Obesity Is Associated with Sustained Symptomatology and Unique Inflammatory Features in Children with Asthma

Obesity complicates the clinical manifestations of asthma in children. However, few studies have examined longitudinal outcomes or markers of systemic inflammation in obese asthmatic children. We hypothesized that obese children with asthma would have: (1) poorer clinical outcomes over 12 months, (2) decreased responsiveness to systemic corticosteroid administration, (3) greater markers of systemic inflammation, and (4) unique amino acid metabolites associated with oxidative stress. Children 6 to 17 years of age (lean, N= 257; overweight, N= 99; obese, N= 138) completed a baseline visit and follow-up visit at 12 months. Outcome measures included asthma control, quality of life, lung function, and exacerbations. A subset received intramuscular triamcinolone and were re-evaluated at 7(+7) days. Leptin, adiponectin, C-reactive protein, total cholesterol, interleukin (IL)-1β, IL-6, IL-17, interferon gamma, tumor necrosis factor alpha, monocyte-chemoattractant protein-1, and amino acid metabolites were also quantified in plasma as potential biomarkers of outcomes in obese children. Obesity was associated with more symptoms, poorer quality life, and more exacerbations that persisted over 1 year despite greater medication requirements. Obese children also had minimal clinical improvement in asthma control and lung function after intramuscular triamcinolone. Leptin, C-reactive protein, and amino acid metabolites associated with glutathione synthesis and oxidative stress differed in obese children. Within the obese group, lower concentrations of arginine-related metabolites also distinguished uncontrolled from controlled asthma at 12 months. Obesity is associated with poorer asthma outcomes and unique systemic inflammatory features that may not be adequately modified with conventional asthma therapies. Novel approaches may be needed given increased symptoms and unique inflammation and oxidative stress in obese children with asthma.

Peripheral Airway Impairment and Dysanapsis Define Risk of Uncontrolled Asthma in Obese Asthmatic Children

Factors that determine the relationship between obesity and poor outcomes in asthmatic children are not well understood. Dysanapsis and peripheral airway impairment (PAI) could provide an explanation in the obese asthmatic patient. To determine the effect of obesity on increased dysanapsis and PAI and establish the effect of obesity, dysanapsis, and PAI on increased risk of uncontrolled asthma. We evaluated 206 children with moderate to severe asthma, aged 4-18 years, to determine the relationship of body mass index (BMI) to increased dysanapsis and PAI, using reference values. We examined the probability of obesity, dysanapsis, and PAI increasing the risk of uncontrolled asthma by BMI categorically and BMI z scores using generalized linear model analyses. Compared with normal-weight children, overweight and obese children had increased forced vital capacity % predicted and obesity increased odds of dysanapsis by 2.32 (P=.04), while PAI showed an age-dependent effect, with increased odds of 2.09 for children younger than 12 years (P=.08) and 54.14 for those 12 years and older (P= .003). For each unit increase in BMI z score, there was an increased odds ratio of 1.57 for dysanapsis (P= .009), greater in males, OR of 3.10, P = .009, and of 1.39 for PAI for those younger than 12 years (P= .042) and of 4.60 for those 12 years and older (P= .002). Obesity's relationship to uncontrolled asthma was indirect, as not significant when adjusted for the direct effect of dysanapsis and PAI, which were highly significant predictors, with increased odds of 28.01 for dysanapsis for those younger than 12 years (P < .001) and of 3.09 for PAI (P= .005). Overweight and obesity significantly increase odds of dysanapsis and PAI, in an age and gender-specific manner, increasing the probability of uncontrolled asthma.

School-age obese asthmatic children have distinct lung function measures from lean asthmatics and obese children

Background The lung functions of children with obese asthma seem to be distinct from those of obese children or lean asthmatics. Aim To measure baseline lung function, exercise-induced bronchoconstriction (EIB), and bronchial hyperreactivity (BHR) in school-age obese asthmatics (OA group) and to compare the data with obese children (O group), lean asthmatics (A group), and healthy controls (H group). Methods One hundred seventy school-age children were enrolled in this prospective cross-sectional study. Baseline fractionated exhaled nitric oxide (FeNO), and baseline, post-exercise (post-E), and post-bronchodilation (post-BD) impulse oscillometry (IOS) and spirometry tests were performed. EIB and BHR were evaluated based on the difference (Δ) in post-E - baseline, and post-BD – baseline values. Results The mean FeNO level was higher in the OA group than in the other groups (p = 0.002). Baseline zR5 and R5-20 were higher (p = 0.013 and p = 0.044), but zFEF25-75 was lower (p < 0.01), in the OA group. ΔPost-E – baseline zFEV1 was lower in the A group (p = 0.003) but was higher in the OA group (p = 0.014) than the other groups. ΔPost-BD – baseline zFEV1 was lower in the H group compared to the other three groups (p = 0.004), but no significant difference was observed among the O, A, and OA groups (p > 0.05). Conclusion Higher airway inflammation (high FeNO), peripheral airway resistance (high zR5 and zR5-20) and a lower peripheral airway flow (low FEF25-75) were observed at baseline measurement in school-age obese asthmatics compared to lean asthmatics and obese children. Obese asthmatics had no EIB but exhibited a similar BHR to that of asthmatics.

Features of the course of bronchial asthma in obese children

Features of the course of bronchial asthma in obese children

Atopy and pulmonary function among healthy-weight and overweight/obese children with asthma.

Epidemiologic studies have found low/absence of atopy in obese asthmatic children, but the association or lack thereof of atopy with disease morbidity, including pulmonary function, in obese asthma is not well understood. We sought to define the association of atopy with pulmonary function in overweight/obese minority children with asthma. In a retrospective chart review of 200 predominantly minority children evaluated at an academic Pediatric Asthma Center over 5 years, we compared the prevalence of atopy, defined as 1 positive skin prick test or serum-specific immunoglobulin E quantification to environmental allergens, and its association with pulmonary function in overweight/obese (body mass index [BMI] > 85th percentile) (n = 99) to healthy-weight children (BMI, 5th-85thpercentile for age) (n = 101). In a cohort comprised of 47.5% Hispanics and 39.5% African Americans, 81% of overweight/obese and 74% of healthy-weight children were atopic. While atopic healthy-weight children had lower percent-predicted forced expiratory volume in the first second (FEV1 ) (93 ± 13.6 vs 107% ± 33.2%, P = .03) and lower percent-predicted forced vital capacity (FVC) (93% ± 12.2% vs 104% ± 16.1%, P = .01) as compared to nonatopic children, atopy was not associated with FEV1 (P = .7) or FVC (P = .17) in overweight/obese children. Adjusting for demographic and clinical variables, atopy was found to be an independent predictor of FEV1 and FVC in healthy-weight (β = -2.4, P = .07 and β = -1.7, P = .04, respectively) but not in overweight/obese children (β = .6, P = .5 and β = .8, P = .3). Atopy is associated with lower lung function in healthy-weight asthmatics but not in overweight/obese asthmatics, supporting the role of nonallergic mechanisms in disease burden in pediatric obesity-related asthma.

Evaluation of Regulatory T cells in Obese Asthmatic Children

Background: Asthma is an airway inflammatory disorder with functional and structural changes. Regulatory T (T reg) cells are important in controlling immune responses. The study was aimed to investigate the frequency of Treg cells in obese asthmatic children, in comparison to non-obese asthmatics and healthy matched controls .Methods: In addition to anthropometric and body mass index (BMI) assessment, peripheral blood samples from healthy control subjects (n = 30) and asthmatic obese (n=30) and asthmatic non-obese children (n=30) were examined for serum IgE, eosinophils counts, and flowcytometric measurement of CD4+CD25+CD127 low/neg- T cells. Pulmonary function testing was performed for asthmatic children . Results: Obese asthmatics showed significantly higher levels of serum IgE and CD4+CD25+CD127 low/neg- T cells as compared to healthy controls (p<0.001, 0.001, respectively) while comparable numbers of T reg cells were found among obese and non-obese asthmatic children. Asthmatics receiving inhaled corticosteroids (ICS) showed higher percentages of CD4+CD25+CD127 low/neg- T cells than the non-receivers (median 11.8% vs 8.8%, p <0.001). No significant correlations were found between Treg and age, eosinophil percentage, total serum IgE, pulmonary functions, or BMI and its Z score . Conclusion: Our study demonstrates an increased frequency of Treg cells in asthmatic children compared to controls with possible association with the use of ICS but not with obesity. Small sample size and lack of obese non-asthmatic group are the main points of limitation in our study.

ADRB2 gene polymorphism in children with asthma and obesity

Introduction . The peculiarity of the clinical course of asthma in obese children allowed to identify a special phenotype, when the presence and severity of obesity determine a more severe course of asthma, which can serve as a criterion for predicting the worst response to asthma therapy. Asthma, like obesity, is recognized as a classic example of multi-factorial diseases, which are based on a fairly complex gene network. Investigating the genetic basis of both of these complex traits and linking them to the asthma phenotype should improve our understanding of the overall genetic basis of these pathological disorders. Aim . Review of the literature containing research data on available candidate genes that match asthma and obesity to present the current state of the issue, understand the direction of research, and solve problems. Materials and methods. The analysis of publications containing the results of the study of the effect of ADRB2 gene polymorphisms on the course of asthma in obese patients was carried out. Results. The analysis data shows that in general, the literature data on this problem is contradictory. It is emphasized that the strength of the relationship between the presence of predisposition gene polymorphisms is not always sufficient to explain the relationship between asthma and obesity, which leaves many unresolved issues that require further study. Conclusion . The analysis of genetic markers of asthma and obesity indicates the need for a comprehensive approach to research, which will contribute to the improvement and optimization of diagnostic and therapeutic measures.

Leptin and exercise-induced bronchoconstriction in obese asthmatic children

Exercise-induced bronchoconstriction (EIB) in asthmatic children has been associated with obesity. Leptin, the proinflammatory adipokine, is typically increased in obesity, whereas cysteinyl leukotrienes (cysLTs) are the main inflammatory mediators implicated in the pathogenesis of EIB. The aim of this work was to study the possible impact of obesity on the severity of EIB in asthmatic children and the possible association with the adipokine leptin. The study included eighty pre-pubertal asthmatic children divided according to their body mass index (BMI) and response to exercise into four groups; obese exercise-responders (n=20), normal-weight exercise-responders (n=20), obese exercise non-responders (n=20), and normal-weight exercise non-responders (n=20). A baseline spirometry test and a standardized exercise challenge test (ECT) were performed. The severity of EIB was assessed by the maximum percentage fall in forced expiratory volume in 1 second (MF%FEV1) after exercise. The level of fasting serum leptin and the release of cysLTs during exercise were compared between the 4 groups. The MF%FEV1 during exercise was significantly greater in obese responder compared to normal-weight responder patients (p=0.004) and MF%FEV1 was positively correlated with cysLT release during exercise, BMI z-score, waist circumference and serum leptin. CysLT release during exercise was positively correlated with the level of serum leptin (r =0.514, p=0.001). This study reports that the severity of EIB is significantly greater in obese compared to normal-weight asthmatic children and suggests an association between leptin and airway hyperresponsiveness to exercise in obese asthmatic children through a mechanism related to cysLT release

Impact of Weight Loss on Ventilatory Functions in Obese Asthmatic Children

Impact of Weight Loss on Ventilatory Functions in Obese Asthmatic Children

Impact of exercise in high-humidity on heart rate variability and salivary oxidative stress in obese and lightweight asthmatic children.

Asthma and obesity are becoming increasingly common among children. Such conditions are known to negatively affect both cardiac autonomic function and oxidative stress. We therefore investigated the heart rate variability (HRV) and oxidative (malondialdehyde, MDA) response to exercise within a high humidity environment (~65%) in obese and lightweight asthmatic children. Forty-two children participated in this study and were categorized into four groups: obese asthmatic (OA, N.=10), obese non-asthmatic (ONA, N.=15), lightweight asthmatic (LA, N.=10), and lightweight non-asthmatic (LNA, N.=7). Time-domain and nonlinear indices of HRV were assessed at rest, during, and immediately after exercise. Further, saliva samples were collected immediately before and after exercise and analyzed for the determination of MDA. HRV significantly decreased during and after exercise compared to baseline (P<0.05) with short-term fractal scaling exponent (α1) for the LNA group significantly smaller than the OA group after exercise (P<0.05). In contrast, the long-term fractal scaling exponent (α2) was greater after exercise compared to baseline and during exercise for all groups (P<0.05). MDA significantly decreased after exercise compared to baseline (P<0.05). We also found significant correlations after exercise between salivary levels of MDA with HRV components (i.e., RMSSD, SD1, and α2) in asthmatic groups (all P<0.05). Our findings showed that exercise in high humidity environment does not significantly differentiate the autonomic response among children with various conditions (i.e., obese, asthmatic and healthy). However, a significant relationship was found between HRV and MDA in asthmatic children after exercise, highlighting the inter-relationship between oxidative stress markers and autonomic function in asthmatic children.

Characterising a Weight Loss Intervention in Obese Asthmatic Children.

The prevalence of obesity in asthmatic children is high and is associated with worse clinical outcomes. We have previously reported that weight loss leads to improvements in lung function and asthma control in obese asthmatic children. The objectives of this secondary analysis were to examine: (1) changes in diet quality and (2) associations between the baseline subject characteristics and the degree of weight loss following the intervention. Twenty-eight obese asthmatic children, aged 8–17 years, completed a 10-week diet-induced weight loss intervention. Dietary intake, nutritional biomarkers, anthropometry, lung function, asthma control, and clinical outcomes were analysed before and after the intervention. Following the intervention, the body mass index (BMI) z-score decreased (Δ = 0.18 ± 0.04; p < 0.001), %energy from protein increased (Δ = 4.3 ± 0.9%; p = 0.002), and sugar intake decreased (Δ = 23.2 ± 9.3 g; p= 0.025). Baseline lung function and physical activity level were inversely associated with Δ% fat mass. The ΔBMI z-score was negatively associated with physical activity duration at baseline. Dietary intervention is effective in achieving acute weight loss in obese asthmatic children, with significant improvements in diet quality and body composition. Lower lung function and physical engagement at baseline were associated with lesser weight loss, highlighting that subjects with these attributes may require greater support to achieve weight loss goals.

Association between body mass index and asthma severity in Arab pediatric population: A retrospective study.

Increased body mass index (BMI) has been associated with an increased prevalence of asthma in children, however the association between BMI status and asthma severity has been less well defined. The aim of this study was to describe the association between childhood obesity and asthma severity, frequency of hospital and emergency department visits as well as pattern of aeroallergen sensitization. A retrospective study was conducted at pediatric outpatient clinics in University Hospital Sharjah. All consecutive patients aged 6 years and above, with confirmed diagnosis of asthma visiting the outpatient pediatric clinics during 2018 were included in this study. Sources of information were the patient’s medical file, laboratory data, pharmacy data, as well as reports from the pediatric in charge. This study included 164 children with asthma. 63% of asthma patients were male. The vast majority of patients were from Arab ethnicities (n = 154, 94%), majority had mild asthmatic conditions (n = 133, 81%), and one-third were either overweight or obese (n = 52, 32%). Overweight or obese asthmatic children with BMI percentile of equal or more than 85% was associated with more asthma severity (odds ratio [OR]: 3.27, 95% confidence interval [CI]: 1.42–7.54; P = 0.005), as well as more frequent asthma related hospital visits (OR: 2.53, 95% CI: 1.22–5.26; P = 0.013). Overweight asthmatic children with BMI between the 85th and 94th percentiles and obese asthmatic children with BMI equal to or greater than 95th percentile are associated with more severe asthma phenotype and more frequent hospital and emergency department visits.

Editorial: Editor-in-Chief

This issue of the Egyptian Journal of Pediatric Allergy and Immunology is inaugurated by a brief report from the Pediatric Allergy and Immunology Unit of Ain Shams University, Egypt on its approach and attitude towards the COVID-19 pandemic and the challenges that its staff members are meeting towards control of its morbidity in their patients. The unit is carrying several research works on the phenotypic features of the disease and some of them are currently under publication .The review article of this issue is about wheat allergy. The authors stress that management of IgE mediated wheat allergy is mainly based on avoiding its allergens, careful reading of market labels, and written instruction to deal with anaphylactic reaction. Four original articles were carefully selected after peer-reviewing by international and local experts in the field. The health-related quality of life (HRQOL) is the focus of attention in two of them. A group of Egyptian children with atopic dermatitis and their parents underwent a comprehensive HRQOL evaluation and many problems were thus identified. Another article thought to outline the HRQOL defects in juvenile idiopathic arthritis and concluded that physical disability and pain as well as social drawbacks are major aspects that need intervention to help those children lead a normal life. In the third article, the authors sought to investigate the effect of BclI Polymorphism of NR3C1 gene on asthma phenotypes in Egyptian children. Indeed, exploring the local genetic background of this expanding problem will help design better intervention strategies. The last article presents the results of a work conducted on a group of obese asthmatic children aiming to enumerate the regulatory T cells (Tregs) among their lymphocytes. The authors concluded that Tregs are increased in the asthmatic children whether obese or not. However, the absence of an obese non-asthmatic group is a limiting point in the study .An English/Arabic glossary that contains a list of allergy and immunology relevant terms and expressions is included as well as a collection of abstracts from recent international publications in allergy/immunology. I would like to remind you that the WAO e-letter (News & Notes) is displayed on our website both in English and Arabic on monthly basis. On our homepage, you will find links to the World Allergy Organization (WAO) website and the WAO online journal. I encourage you indeed to submit your articles to this very well peer-reviewed journal .Please get the latest updates on ESPAI activities from http://www.espai-eg.org/scientific.htm and from our society’s Facebook page https://www.facebook.com/TheESPAI. Hopefully, our 16th International Congress will be held in March 2021 and will probably be fully virtual unless the pandemic comes to an end with God’s will.We encourage you visit our journal’s website (https://www.jespai.org/) and we look forward to receiving some feedback about this issue. You may contact us through the “contact us” icon in our website on your left-hand side.

Carotenoids, fatty acids and disease burden in obese minority adolescents with asthma

Paediatric obesity-related asthma causes high disease burden, is associated with metabolic abnormalities, has few therapeutic options, and disproportionately affects urban minority children. Although poor diet quality is linked to asthma, the association of nutritional status with disease burden among children with obesity-related asthma is not well understood. To quantify nutritional status, defined as concentrations of serum carotenoids and n-3 fatty acids, and its association with pulmonary function and metabolic markers among obese asthmatic children. We quantified serum carotenoids and fatty acids in a study cohort of 158 urban minority adolescents including 39 obese asthmatics, 39 healthy weight asthmatics, 38 obese controls and 42 healthy weight controls and compared between the groups. We correlated carotenoid and fatty acid levels with pulmonary function indices and with insulin resistance and dyslipidemia. Mean total carotenoids were lowest in obese asthmatic children (0.41μg/mL), lower than healthy weight asthmatics (0.52μg/mL, P<0.05) and healthy weight controls (0.60μg/mL, P<0.001). n-6/n-3 polyunsaturated fatty acid (PUFA) ratio also differed between the groups (P<0.05). Total carotenoids positively correlated with per cent-predicted FEV1 and inversely correlated with insulin resistance among obese asthmatics only. n-6/n-3 PUFA ratio inversely correlated with per cent-predicted FEV1 in obese asthmatics. Our findings suggest that carotenoids, which are lowest in obese asthmatic children, may have protective effects on metabolic health and pulmonary function among obese asthmatic children. Similarly, n-3 PUFA appear to be protective for pulmonary function.

Study of the association between obesity, plasminogen activator inhibitor-1, and asthma in preschool children

Background Asthma and obesity are recognized as pathological conditions characterized by systemic inflammatory state. Plasminogen activator inhibitor-1 (PAI-1) is the most important endogenous inhibitor of tissue plasminogen activator and uro-plasminogen activator and is thus the major physiological inhibitor of both fibrinolysis and plasmin activation. Purpose To identify the role of PAI-1 in a group of Egyptian obese asthmatic preschool children and to identify some risk factors for simple obesity and asthma, such as age, sex, socioeconomic status, and type of feeding. Patients and methods This study was a cross-sectional case–control study that was carried out on 90 children attending Foua Hospital for health insurance in Kafar Elsheikh and Alzahraa University Hospital from September 2015 to March 2017. Results The frequency of obese children with asthma of high socioeconomic level was higher (63.3%) in comparison with nonobese children with asthma and controls. The prevalence of patients with asthma living in urban areas was higher than those living in rural areas (66.7%). Children who received artificial feeding are more frequent in asthmatic obese (66.7%) when compared with asthmatic nonobese and controls. PAI-1 had significant increase in asthmatic obese (1549.24±340.54) in comparison with other groups. Conclusion Asthmatic obese children are more frequent among high socioeconomic level and in urban areas. PAI-1 is significantly higher in asthmatic obese than asthmatic nonobese children.