An Overview of the Obese-Asthma Phenotype in Children

Abstract

Asthma is the most common chronic disease in childhood. Overweight and obesity are included among the comorbidities considered in patients with difficult-to-treat asthma, suggesting a specific phenotype of the disease. Therefore, the constant increase in obesity prevalence in children and adolescents raises concerns about the parallel increase of obesity-associated asthma. The possible correlation between obesity and asthma has been investigated over the last decade by different authors, who suggest a complex multifactorial relationship. Although the particular non-eosinophilic endotype of obesity-related asthma supports the concept that high body weight precedes asthma development, there is ongoing debate about the direct causality of these two entities. A number of mechanisms may be involved in asthma in combination with obesity disease in children, including reduced physical activity, abnormal ventilation, chronic systemic inflammation, hormonal influences, genetics and additional comorbidities, such as gastroesophageal reflux and dysfunctional breathing. The identification of the obesity-related asthma phenotype is crucial to initiate specific therapeutic management. Besides the cornerstones of asthma treatment, lifestyle should be optimized, with interventions aiming to promote physical exercise, healthy diet, and comorbidities. Future studies should clarify the exact association between asthma and obesity and the mechanisms underlying the pathogenesis of these two related conditions with the aim to define personalized therapeutic strategies for asthma management in this population.

Interaction between serum cotinine and body mass index on asthma in the children: a cross-sectional study

“…However, Lang et al [ 23 ] showed that asthma could be driven by both duration and severity of overweight, and a meta-analysis [ 24 ] concluded that there was a bidirectional association between obesity and asthma in childhood and adolescence. The relationship between asthma and overweight/ obesity remains controversial, and the underlying causal relationship is unclear [ 21 , 25 ], and further researches are needed [ 26 ].…”

Do not forget asthma comorbidities in pediatric severe asthma!

“…Obesity is a modifiable risk factor for asthma and weight loss has been shown to improve control of asthma symptoms (20), so that diet, exercise and behavioral therapy should be always encouraged in obese asthmatic and nonasthmatic children and the possibility of practicing physical activity free from respiratory symptoms must always be part of the therapeutic goals (21). As suggested by Fainardi and colleagues, in a child with obese-asthma phenotype, a stepwise approach including the evaluation and management of obesity-associated comorbidities, mainly OSAS and GERD, is fundamental (22).…”

Diet and Asthma: A Narrative Review

“…A visual representation of T2H and T2L asthma and the involved lymphocytes and cytokines are presented in Figure 1. The diverse mechanisms underlying the asthma-obesity phenotype may be linked to mechanical impediment, hormonal influence, inflammation [5,14,29], diet [5,30], metabolic dysregulation, and genetic and immune factors [5,29].…”