Adiposity, Fractional Exhaled Nitric Oxide, and Asthma in U.S. Children

Han, Yueh‐Ying; Forno, Erick; Celedón, Juan C.

doi:10.1164/rccm.201403-0565oc

Cited by 79 publications

(56 citation statements)

References 47 publications

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“…In CAMP, ICSs had no effect on the association between BMI and dysanapsis, and, despite ICS treatment, children with dysanapsis remained at higher risk of severe asthma exacerbations. Our findings thus suggest that airway dysanapsis partly explains previous reports of a strong link between obesity and increased morbidity (8,15,41) or reduced response to treatment (2,42) in children with asthma. We speculate that obese children with dysanapsis may have airflow obstruction that is anatomical and/or developmental and thus at least partly not related to bronchospasm or airway inflammation.…”

Section: Discussionsupporting

confidence: 70%

“…On the contrary, studies in children have shown that obesity is associated with reduced FEV 1 /FVC (an obstructive deficit) (8,(14)(15)(16)(17). However, rather than low FEV 1 , researchers in several studies have reported a normal or high FEV 1 and a high FVC; thus, we hypothesized that the changes seen in obese children may be related to dysanapsis (normal flows in large lungs).…”

Section: At a Glance Commentarymentioning

confidence: 88%

“…Among children and adults, obesity is a risk factor for asthma, asthma morbidity, reduced quality of life, and reduced response to inhaled corticosteroids (ICSs) (1)(2)(3). Obesity may impact asthma through multiple mechanisms, including changes in lung mechanics (4), comorbidities such as gastroesophageal reflux (5), dietary intake (6), alterations in insulin and/or glucose metabolism (7), and systemic inflammation (8).…”

Section: At a Glance Commentarymentioning

confidence: 99%

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Obesity and Airway Dysanapsis in Children with and without Asthma

Forno

Weiner

Mullen

et al. 2017

Am J Respir Crit Care Med

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204

137

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Rationale: For unclear reasons, obese children with asthma have higher morbidity and reduced response to inhaled corticosteroids.Objectives: To assess whether childhood obesity is associated with airway dysanapsis (an incongruence between the growth of the lungs and the airways) and whether dysanapsis is associated with asthma morbidity.Methods: We examined the relationship between obesity and dysanapsis in six cohorts of children with and without asthma, as well as the relationship between dysanapsis and clinical outcomes in children with asthma. Adjusted odds ratios (ORs) were calculated for each cohort and in a combined analysis of all cohorts; longitudinal analyses were also performed for cohorts with available data. Hazard ratios (HRs) for clinical outcomes were calculated for children with asthma in the Childhood Asthma Management Program.Measurements and Main Results: Being overweight or obese was associated with dysanapsis in both the cross-sectional (OR, 1.95; 95% confidence interval [CI], 1.62-2.35 [for overweight/obese compared with normal weight children]) and the longitudinal (OR, 4.31; 95% CI, 2.99-6.22 [for children who were overweight/obese at all visits compared with normal weight children]) analyses. Dysanapsis was associated with greater lung volumes (FVC, vital capacity, and total lung capacity) and lesser flows (FEV 1 and forced expiratory flow, midexpiratory phase), and with indicators of ventilation inhomogeneity and anisotropic lung and airway growth. Among overweight/obese children with asthma, dysanapsis was associated with severe disease exacerbations (HR, 1.95; 95% CI, 1.38-2.75) and use of systemic steroids (HR, 3.22; 95% CI, 2.02-5.14).Conclusions: Obesity is associated with airway dysanapsis in children. Dysanapsis is associated with increased morbidity among obese children with asthma and may partly explain their reduced response to inhaled corticosteroids.

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Section: Discussionsupporting

confidence: 70%

Section: At a Glance Commentarymentioning

confidence: 88%

Section: At a Glance Commentarymentioning

confidence: 99%

See 1 more Smart Citation

Obesity and Airway Dysanapsis in Children with and without Asthma

Forno

Weiner

Mullen

et al. 2017

Am J Respir Crit Care Med

Self Cite

204

137

View full text Add to dashboard Cite

show abstract

“…110 It is hypothesized that these disparate reports either support heterogeneity in the pathophysiology of obesity-related asthma 116 or are reflective of inherent differences in disease severity. 108 As noted in normal-weight asthma, although classic asthma is atopic, involving eosinophils and Th2 cells, severe asthma, even among normal-weight individuals, is nonatopic, mediated by neutrophils. 117 Whether similar variability in the involvement of innate immune pathways comprising Th1 cells, M1 macrophages, and neutrophils occurs in the pathogenesis of obesity-related asthma needs further investigation.…”

Section: Obesity-mediated Inflammation and Asthmamentioning

confidence: 98%

Pediatric Obesity-Related Asthma: The Role of Metabolic Dysregulation

2016

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The burden of obesity-related asthma among children, particularly among ethnic minorities, necessitates an improved understanding of the underlying disease mechanisms. Although obesity is an independent risk factor for asthma, not all obese children develop asthma. Several recent studies have elucidated mechanisms, including the role of diet, sedentary lifestyle, mechanical fat load, and adiposity-mediated inflammation that may underlie the obese asthma pathophysiology. Here, we review these recent studies and emerging scientific evidence that suggest metabolic dysregulation may play a role in pediatric obesity-related asthma. We also review the genetic and epigenetic factors that may underlie susceptibility to metabolic dysregulation and associated pulmonary morbidity among children. Lastly, we identify knowledge gaps that need further exploration to better define pathways that will allow development of primary preventive strategies for obesity-related asthma in children.

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“…CHEN et al [5] showed that central obesity most accurately predicted asthma in the nationwide Taiwan Children Health Study. HAN et al [6] reported that adiposity indicators were associated with asthma in children with exhaled nitric oxide fraction (FeNO) as a biomarker of eosinophilic airway inflammation and that among children with asthma, adiposity was associated with worse asthma severity or control in those with high FeNO. In 2014, several studies also reported an increased prevalence of overweight and obesity in patients with CF even in those with pancreatic insufficiency [7][8][9][10].…”

Section: Adiposity and Respiratory Disease Riskmentioning

confidence: 99%

Nutritional advances in patients with respiratory diseases

Schols

2015

Eur Respir Rev

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Nutritional issues are increasingly recognised in the course of respiratory diseases, from primary prevention to advanced disease care. During the 2014 ERS International Congress in Munich, Germany, the topic was addressed in a Clinical Year in Review session. This review highlights new insights in generic and disease-specific nutritional issues from recently published peer-reviewed articles. The clinical relevance of obesity was highlighted in primary and secondary prevention across all respiratory diseases. Radiographic imaging was explored for characterisation of metabolic phenotypes as an integrated part of diagnostic work-up. Muscle regenerative defects and the autophagy-lysosome pathway were identified as new leads for combatting muscle wasting. @ERSpublications Nutritional issues need to be considered in respiratory disease, from primary prevention to advanced disease care http://ow.ly/GVI5D

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Adiposity, Fractional Exhaled Nitric Oxide, and Asthma in U.S. Children

Cited by 79 publications

References 47 publications

Obesity and Airway Dysanapsis in Children with and without Asthma

Obesity and Airway Dysanapsis in Children with and without Asthma

Pediatric Obesity-Related Asthma: The Role of Metabolic Dysregulation

Nutritional advances in patients with respiratory diseases

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