Decreased response to inhaled steroids in overweight and obese asthmatic children

Abstract

Background The mechanisms and consequences of the observed association between obesity and childhood asthma are unclear. Objectives To determine the effect of obesity on treatment responses to inhaled corticosteroids in asthmatic children. Methods We performed a post hoc analysis to evaluate the interaction between body mass index (BMI) and treatment with inhaled budesonide on lung function in the Childhood Asthma Management Program (CAMP) trial. Participants were then stratified into overweight/obese and non-overweight, and their response to inhaled budesonide was analyzed longitudinally over the 4 years of the trial. Results There was a significant interaction between BMI and budesonide for pre-BD FEV1/FVC (P=0.0007) and bronchodilator response (BDR) (P=0.049), and a non-significant trend for an interaction between BMI and budesonide on pre-BD FEV1 (P=0.15). Non-overweight children showed significant improvement with inhaled budesonide in lung function (FEV1, FEV1/FVC, and BDR) during the early (years 1–2) and late stages (years 3–4) of the trial. Overweight/obese children had improved FEV1 and BDR during the early but not the late stage of the trial, and showed no improvement in FEV1/FVC. When comparing time points where both groups showed significant response, the degree of improvement among non-overweight children was significantly greater than in overweight/obese children at most visits. Non-overweight children had a 44% reduction in the risk of ER visits or hospitalizations throughout the trial (P=0.001); there was no reduction in risk among overweight/obese (P=0.97). Conclusions Compared to children of normal weight, overweight/obese children in CAMP showed a decreased response to inhaled budesonide on measures of lung function and ER visits/hospitalizations for asthma.

Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus

“…11,30 Abnormal lung function may be further complicated by a decreased response to both corticosteroids and bronchodilators in overweight children. 31,32 Our study strengthens similar findings of poor control in obese patients with asthma in other studies [33][34][35] because it assesses a wider age range, uses chart review, and controls for asthma severity.…”

Childhood obesity and in-hospital asthma resource utilization

“…[4][5][6][7][8][9][10] Although the mechanisms driving the association between obesity and in-hospital outcomes are not fully known, for asthma it is believed that adipocytes expressing inflammatory markers create a low level of systemic inflammation, thereby increasing the severity of allergic-type illnesses and decreasing the response to anti-inflammatory medications, such as steroids. [11][12][13][14][15][16][17][18] The relationship of obesity and in-hospital asthma outcomes is of particular interest because status asthmaticus is the most common reason for admission in children aged 3 to 12 years, accounting for approximately 150,000 admissions (7.4% of all hospitalizations for children and adolescents) and $835 million in hospital costs annually. 19 Few prior studies have examined the association of obesity and asthma outcomes in the in-hospital setting.…”

“…The median number of albuterol treatments in the inpatient setting was 14 (IQR, [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]. When albuterol treatments given in the ED were included, the median number of treatments increased to 38 (IQR, .…”

Association between obesity and asthma – epidemiology, pathophysiology and clinical profile

“…As in the case of adults, amongst children too, obesity is more closely related to non-atopic asthma (154) . Similarly, it has also been observed that obese children have a lower response to treatment with inhaled steroids and are at a higher risk of emergency hospitalisations than asthmatics with normal weight (155) . Obese children also tend to have lower disease control, higher severity of symptoms and more exacerbations (156) .…”