PracticeUpdate Editorial Team, 2014 Nov 07

November 7, 2014 – Atlanta – Childhood obesity and severe persistent difficult-to-control (FTC) asthma are significantly associated. This conclusion was presented at the 2014 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting in Atlanta, Georgia, from November 6 to 10.

Yasmin Hamzavi Abedi, MD, of Eastern Virginia Medical School, Norfolk, Virginia, explained that it is important to identify clinical features associated with asthma to develop effective new interventions. Clinical observation led her to hypothesize that the proportion of overweight/obesity is significantly higher in DTC than in well-controlled asthmatic children.

Maripaz Morales, MD, also of Eastern Virginia Medical School, said, “A large number of our pediatric asthma patients have moderate-to-sever disease and they are largely uncontrolled. We’ve looked at several contributing factors including reflux and chronic sinus infection. By knowing the variables that might be responsible for the poor control, we thought we might be better able to treat these patients successfully.”

The team performed a retrospective chart review of 100 patients aged 5 to 18 years diagnosed with asthma in their children’s hospital between 2013 and 2014. The 50 children were identified as having severe persistent DTC asthma based on their required high dose of ≥1000 µg daily of inhaled corticosteroids (ICS). The control group of 50 children included subjects with well-controlled mild or moderate persistent asthma defined by a dose of ≤500 µg daily of ICS. A subject’s weight status was classified by the BMI percentile for age as normal weight (BMI < 85%), overweight (BMI 85 – 94%), or obese (BMI ≥95%). The BMI percentile in the DTC asthma group was significantly higher than in the well-controlled group (75.74 ± 25.63 vs 51.69 ± 24.43, P < 0.001). Thirty-six percent of DTC asthmatic children were obese vs 0% of well-controlled asthmatic children, P < 0.001, 14% of overweight vs 10% of well-controlled asthmatic children (difference not significant), and 50% of normal weight vs 90% of well-controlled asthmatic children, P < 0.001. Mean age in DTC asthmatic children was 13.2 ± 3.3 vs 10.0 ± 3.2 in the well-controlled group (P < 0.001). Notably, a significant difference was observed in race between the DTC and well-controlled group. Seventy-four percent of DTC asthmatic children were African-American (AA) vs 30% AA in the well-controlled asthmatic children, P < 0.001. There was no significant difference in gender between DTC and well-controlled asthmatic children. Dr. Hamzavi Abedi concluded that the results suggest a significant association between obesity and severe persistent DTC asthma. The finding underlines the need for new treatment approaches for DTC asthmatic children involving simultaneous treatment of their asthma and obesity. Dr. Morales said, “Now that we know that obesity contributes to the poor asthma control, we’ll look at obesity-related factors such as leptin and cholesterol levels. Our ultimate endpoint is to treat the poorly controlled child with asthma successfully.” Story Source