Overweight/Obesity and Risk of Seasonal Asthma Exacerbations

Schätz, Michael; Zeiger, Robert S.; Zhang, Feng; Chen, Wansu; Yang, Su-Jau; Camargo, Carlos A.

doi:10.1016/j.jaip.2013.07.009

Cited by 74 publications

(29 citation statements)

References 22 publications

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“…In contrast, in a far larger cohort of 10,700 patients aged 5-17 years, Schatz et al 25 found a linear increase in the proportion of patients experiencing exacerbations during fall and winter by BMI category (normal, overweight, and obese). These different findings may reflect the different racial/ethnic composition of the populations and the greater proportion of overweight/obese subjects in our cohort.…”

Section: Discussionmentioning

confidence: 85%

Seasonal risk factors for asthma exacerbations among inner-city children

Teach¹,

Gergen²,

Szefler³

et al. 2015

Journal of Allergy and Clinical Immunology

148

114

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Background Exacerbations of asthma remain common even in children and adolescents despite optimal medical management. Identification of host risk factors for exacerbations is incomplete, particularly for seasonal episodes. Objective Define host risk factors for asthma exacerbations unique to their season of occurrence. Methods This is a retrospective analysis of patients aged 6-20 years who comprised the control groups of the Asthma Control Evaluation trial and the Inner City Anti-IgE Therapy for Asthma trial. Univariate and multivariate models were constructed to determine if patient demographic and historical factors, allergic sensitization, fractional exhaled nitric oxide, spirometric measurements, asthma control, and treatment requirements were associated with seasonal exacerbations. Results The analysis included 400 patients (54.5% male; 59.0% African American; median age 13 years). Exacerbations occurred in 37.5% of participants over the periods of observation and were most common in the fall (28.8% of participants). In univariate analysis, impaired pulmonary function was significantly associated with greater odds of exacerbations for all seasons, as was an exacerbation in the previous season for all seasons except spring. In multivariate analysis, exacerbation in the previous season was the strongest predictor in fall and winter while a higher requirement for inhaled corticosteroids was the strongest predictor in spring and summer. The multivariate models had the best predictive power for fall exacerbations (30.5% variance attributed). Conclusions Among a large cohort of inner city children with asthma, patient risk factors for exacerbations vary by season. Thus, individual patient information may be beneficial in strategies to prevent these seasonal events. Clinical Implications Inner city children remain at risk for asthma exacerbations despite appropriate therapy. Because their risk factors vary by season, strategies to prevent them may need to differ as well. Capsule summary Risk factors for asthma exacerbations among inner city children varied by season. Fall exacerbations were the most common and the most predictable based on a compilation of historical and clinical variables.

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Section: Discussionmentioning

confidence: 85%

Seasonal risk factors for asthma exacerbations among inner-city children

Teach¹,

Gergen²,

Szefler³

et al. 2015

Journal of Allergy and Clinical Immunology

148

114

View full text Add to dashboard Cite

show abstract

“…For example, in the Portugese National Health Survey of over 30,000 individuals, overweight (25.0–29.9 kg/m 2 ), class I obesity (30.0–34.9 kg/m 2 ), class II obesity (35.0–39.9 kg/m 2 ), and class III obesity (≥40.0 kg/m 2 ) were associated with odds ratios (OR) for severe asthma (defined as an emergency room visit for asthma within the last 12 months) of 1.36, 1.50, and 3.70, respectively (28). Similarly, in a study of almost 30,000 U.S. adults and children with persistent asthma, higher body mass index (BMI) was associated with increased risk of asthma exacerbations, defined as oral corticosteroid dispensings linked to an asthma encounter (29). In the U.S., obese adults are at higher risk of hospitalization for asthma than lean adults (30) and in those hospitalized for asthma exacerbations, obesity is associated with a significantly higher risk for mechanical ventilation use and longer hospitalization stays (31, 32).…”

Section: Obesity Increases the Severity Of Asthmamentioning

confidence: 99%

Obesity and severe asthma

Tashiro

Shore

2019

Allergology International

106

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Obesity is an important global health issue for both children and adults. Obesity increases the prevalence and incidence of asthma and also increases the risk for severe asthma. Here we describe the features of severe asthma phenotypes for which obesity is a defining characteristic, including steroid resistance, airway inflammation, and co-morbidities. We also review current concepts regarding the mechanistic basis for the impact of obesity in severe asthma, including possible roles for vitamin D deficiency, systemic inflammation, and the microbiome. Finally, we describe data indicating a role for diet, weight loss, and exercise in the treatment of severe asthma with obesity. Better understanding of the mechanistic basis for the role of obesity in severe asthma could lead to new therapeutic options for this population.

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“…39, 40 Although the exact mechanism was not clear, Schatz et al found that an elevated body mass index increased the risk for asthma exacerbations in both children and adults with adults being particularly susceptible in the fall and winter months. 41 Likewise, Forno et al discovered that markers of adiposity were associated with asthma severity and control with atopy significantly mediating the effect of adiposity on asthma outcomes. 12 …”

Section: Obesity and Susceptibility To Pollutant Exposuresmentioning

confidence: 99%

Difficult-to-control asthma

Sheehan

Phipatanakul

2015

Current Opinion in Allergy &Amp; Clinical Immunology

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Purpose of review The aim of the present review is to discuss the epidemiology of inadequate asthma control with an examination of contributing environmental factors. Recent findings Despite advances in asthma therapies, a proportion of patients with asthma continue to have difficulty gaining adequate asthma control. Asthma severity and control in childhood is of particular importance as it translates to asthma morbidity in adulthood. Children with comorbid severe allergic rhinitis were more likely to have uncontrolled asthma. Recent data suggest that mouse allergen, more so than cockroach allergen, may be the most relevant urban allergen exposure. Tobacco smoke exposure, even passive exposure, leads to increased asthma symptoms and decreased response to inhaled corticosteroids. Efforts to ban smoking in public places have resulted in promising asthma results for entire populations. Energy saving efforts to tighten a home’s air leaks can lead to increased indoor pollutant levels and, therefore, must be accompanied by efforts to reduce, filter, or exchange indoor pollutants. Obesity is independently associated with decreased asthma control. Furthermore, the detrimental effects of pollutant exposure are enhanced in an overweight individual with asthma. Summary Lack of asthma control can be due to a complex web of factors including adherence, intrinsic factors, and environmental exposures. Further research on intervention strategies is needed to achieve improved rates of asthma control.

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Overweight/Obesity and Risk of Seasonal Asthma Exacerbations

Cited by 74 publications

References 22 publications

Seasonal risk factors for asthma exacerbations among inner-city children

Seasonal risk factors for asthma exacerbations among inner-city children

Obesity and severe asthma

Difficult-to-control asthma

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