Editors' ChoiceAsthma

Weighing Asthma Risk

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Science Translational Medicine  18 Jul 2012:
Vol. 4, Issue 143, pp. 143ec129
DOI: 10.1126/scitranslmed.3004593

Breathing is a daily struggle for the over 7 million children currently living with asthma in the United States. Recent research suggests that there may be a connection between asthma and obesity in these children. Indeed, obesity worsens asthma symptoms and lung function, increases hospitalization risk, and impairs response to asthma therapy. Conversely, being underweight is also a risk factor for developing asthma. However, little is actually known about the connection between extremes in weight status and asthma phenotype in children. Lang et al. investigated the associations between being underweight and obesity with asthma severity, risk of exacerbation, lung function, and intensity of controller therapy prescribed in a cross-sectional study of 10,559 children ages 5 to 17 years from one pediatric asthma clinic over a period of 10 years. Participants were grouped into one of three cohorts based on body mass index (BMI) percentile: <5th percentile (underweight), 5th to 95th percentile (normal/overweight), and >95th percentile (obese).

The authors used a multivariable logistic model to evaluate the associations between BMI percentile cohort group and asthma outcomes. Underweight status was rare (2.5%) compared with prevalence of obesity (26.2%) in this population. However, underweight asthmatics had significantly lower lung function, greater asthma severity, and higher treatment burden as compared with normal/overweight participants. Obesity was associated with greater odds for severe asthma and airflow obstruction compared with normal weight asthmatics. Surprisingly, obesity was not found to be a risk factor for asthma exacerbation or a major contributor to treatment burden.

Despite the limitations of the cross-sectional nature of the design, the authors demonstrate that both extremes in weight affect characteristics and management of children with asthma. Although the exact mechanism of the effect of weight status on pediatric asthma remains to be explained, this study sheds light on this relationship.

J. E. Lang et al., Asthma severity, exacerbation risk, and controller treatment burden in underweight and obese children. J. Asthma 49, 456–463 (2012). [PubMed]

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