Asthma medication in children who are overweight/obese: justified treatment?

Abstract

Background The prevalence of asthma and obesity have increased over the last decades. A possible association between these two chronic illnesses has been suggested, since the prevalence of asthmatic symptoms rises with increasing Body Mass Index (BMI). However, asthma is only one of several possible causes of shortness of breath in obese children. The aim of this study is to evaluate the prevalence of overtreatment with asthma medication in a cohort overweight/obese children with respiratory symptoms visiting a pediatric outpatient clinic. Methods Children referred to a pediatric outpatient clinic aged ≥4- ≤ 18 years with overweight/obesity (defined as BMI-sds > 1.1) and asthmatic symptoms were included. The diagnosis asthma was evaluated and classified in no, unlikely, probable and confirmed asthma, based on clinical parameters and/or spirometry results. Overtreatment was defined as asthma medication prescribed in participants classified as no or unlikely asthma. And undertreatment as probable or confirmed asthma without asthma medication prescribed . Results Three hundred thirty-eight participants were included, of which 92.6% (313/338) had a prescription for asthma medication. Overtreatment was observed in 27.2% (92/338) participants. Nine participants were undertreated. Conclusion More than 25% overtreatment with asthma medication was observed in a cohort overweight/obese children with asthmatic symptoms. This finding emphasizes that the diagnosis of asthma must be confirmed before commencement of medication. The diagnosis of asthma should be based on standard questionnaires evaluating asthmatic symptoms, lung functions test and regular reassessments. Further studies concerning overtreatment with asthma medication in normal weight pediatric populations are warranted, to evaluate whether overtreatment is specific for overweight/obese children.

Influência Da Obesidade Na Asma Em Crianças E Adolescentes

“…Al-ayed et al (2019) No estudo da comparação das citocinas em pacientes asmático controlados e descontrolados, os pacientes descontrolados apresentaram níveis maiores de citocinas. Lentferink et al (2019) No diagnóstico da asma a maioria dos pacientes só tinha o diagnóstico clínico e quando associados com a espirometria poucos tinham resultado na espirometria alterado. Pasic et al (2016) Em análise de parâmetros na espirometria pacientes obesos apresentaram mais resultados alterados.…”

“…O aumento de peso também influencia nos aspectos espirométricos como a redução do volume expiratório forçado no primeiro minuto e a capacidade vital forçada. Soma-se que a asma associada com a obesidade causa resposta insatisfatória na terapia adequada, no controle da asma piorando os sintomas encontrados nessas doenças (PASIC et al, 2016;LENTFERINK et al, 2019).…”

Anti‐inflammatory effects of reticuline on the JAK2/STAT3/SOCS3 and p38 MAPK/NF‐κB signaling pathway in a mouse model of obesity‐associated asthma

“…Obesity patients are in a state of chronic inflammation. 40 Upregulation of inflammatory cytokines in obesity patients may activate the NF-κB signaling. In obese mouse models, activation of NF-κB signaling fed HFD for 12 weeks is approximately 3.5-fold than that of the baseline level.…”

“…Intriguingly, the RANTES level in obesity‐related asthma induced by HDM or OVA was attenuated by reticuline, which might be related to the reduction in p38 phosphorylation by reticuline. Obesity patients are in a state of chronic inflammation 40 . Upregulation of inflammatory cytokines in obesity patients may activate the NF‐κB signaling.…”

Obesity-related asthma and its relationship with microbiota

“…The reason for the lower efficacy in obesity-related asthma is the overuse of asthma medications in more than 25 percent of patients ( Di Genova et al., 2018 ). Some studies have shown obesity has no effect on response to omalizumab treatment; in other studies, obesity may reduce the effectiveness of omalizumab in terms of exacerbating asthma control scores, rescue therapy, and lung function ( Sposato et al., 2018 ; Lentferink et al., 2019 ). Mepolizumab has an effect on the treatment of obesity-related asthma, especially in those with early-onset asthma ( Ortega et al., 2014 ).…”