Asthma and obesity are two of the most common health problems in children in the United States. A growing cohort of literature is attempting to better describe the complex relationship between the two. Obtaining a better understanding of the clinical phenotypes associated with abnormal weight status and severe asthma may help to provide targeted care to this unique patient population Methods: We performed a retrospective chart review of asthmatic patients seen in our outpatient clinic at a Tertiary Pediatric Hospital. Overweight and Obese children (BMI >85 th percentile; OW/Ob group) with asthma were compared to those with a normal BMI. Primary outcomes were spirometry results (pre-bronchodilator FVC, FEV1, FEV1/FVC, and FEF 25-75%). We also looked at the Asthma Control Test (ACT) and serum studies. Results: 269 children with asthma were included in this study. Roughly 43% were overweight or obese, 36.6% were female, 78.9% were African-American, 26.8% had severe persistent asthma and average age was 7.2 years. There were no significant differences in gender, ethnicity, or proportion of severe asthma between the normal BMI and OW/Ob groups. There was no difference in serum eosinophils, FeNO, IgE, courses of oral steroids or hospital admissions between normal BMI and OW/Ob groups, regardless of asthma severity. OW/Ob children with severe persistent asthma had higher serum neutrophil % on CBC (47% vs 40%; p-value 0.046). There was also no significant difference in measures of asthma control (ACT 16.6 vs. 16.9; p=0.81). Of the children with spirometry results (n=185), the OW/Ob group had a higher %predicted FVC (94.5 vs. 89.0, zscore +0.17; p-value =0.02 for both) and lower FEV1/FVC (79.37 vs 83.48 actual, z-score-0.20; p-value=0.008 for both). In children with severe persistent asthma, the OW/Ob group had lower FEV1/FVC (73.09 vs 82.28 actual, z-score-0.80; p-value=0.001 for both) and FEF25-75% predicted (49.3 vs 69.96; p-value=0.01; z-score not significant). Conclusion: Our study supports previous reports of airway dysanapsis in overweight and obese children with asthma. We identified significantly lower FEV1/FVC and FEF25-75% in overweight/obese children with asthma, particularly those with severe asthma, despite no differences in validated (ACT) and traditional measures (admission/oral steroid rates) of asthma control. These results do not seem to be TH2 driven, as eosinophils, FeNO, and IgE are similar in both groups.
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