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Author Notes:

Correspondence: Anne M. Fitzpatrick, PhD, MSCR, 2015 Uppergate Dr, Atlanta, GA 30322; Email: anne.fitzpatrick@emory.edu

Disclosures: W. G. Teague has received consultancy and lecture fees from Merck and Genentech/Novartis and has received payment for developing education presentations from Not One More Life.

A. M. Fitzpatrick has received consultancy fees from MedImmune and Merck.

The rest of the authors declare that they have no relevant conflicts of interest.

Subject:

Research Funding:

This study was funded by National Institutes of Health RO1 NR012021; the National Heart, Lung, and Blood Institute Severe Asthma Research Program U10 HL109164; and the National Center for Advancing the Translational Sciences award no. UL1TR000454.

Keywords:

  • Airflow limitation
  • Asthma
  • Children
  • Cytokines
  • Functional residual capacity
  • Inflammation
  • Obesity
  • Spirometry

Poor Asthma Control in Obese Children May Be Overestimated Because of Enhanced Perception of Dyspnea

Tools:

Journal Title:

Journal of Allergy and Clinical Immunology: In Practice

Volume:

Volume 1, Number 1

Publisher:

, Pages 39-45.e2

Type of Work:

Article | Post-print: After Peer Review

Abstract:

BACKGROUND Although studies in adults have shown a non-TH2 obese asthma phenotype, whether a similar phenotype exists in children is unclear. OBJECTIVE We hypothesized that asthmatic children with obesity, defined as a body mass index above the 95th percentile for age and sex, would have poorer asthma control as well as decreased quality of life, increased health care utilization, and decreased pulmonary function measures as a function of increased TH1 versus TH2 polarization. METHODS This study involved a post hoc analysis of cross-sectional data from 269 children 6 to 17 years of age enrolled in the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Children answered questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, and venipuncture for TH1/TH2 cytokine determination. Asthma control was defined according to national asthma treatment guidelines that are based on prespecified thresholds for lung function and symptom frequency. RESULTS Fifty-eight children (22%) were overweight and 67 (25%) were obese. Obese children did not have poorer asthma control but were more likely to report nonspecific symptoms such as dyspnea and nocturnal awakenings. Obese children did have decreased asthma-related quality of life and increased health care utilization, but this was not associated with airflow limitation. Instead, obese children had decreased functional residual capacity. A unique pattern of TH1 or TH2 polarization was not observed. CONCLUSIONS Poor asthma control in obese children with asthma may be overestimated because of enhanced perception of nonspecific symptoms such as dyspnea that results from altered mechanical properties of the chest wall. Careful assessment of physiologic as well as symptom-based measures is needed in the evaluation of obese children with respiratory symptoms.

Copyright information:

© 2013 American Academy of Allergy, Asthma & Immunology

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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