Pediatric Obesity-Related Asthma: The Role of Metabolic Dysregulation

Vijayakanthi, Nandini; Greally, John M.; Rastogi, Deepa

doi:10.1542/peds.2015-0812

Cited by 76 publications

(72 citation statements)

References 155 publications

(111 reference statements)

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“…This is in line with a meta‐analysis on the relationship between overweight and incident asthma in childhood of Chen et al, which showed a significantly stronger relationship between BMI z ‐score and asthma in boys, compared to girls . This gender different association between BMI and asthma we observed was also disclosed in the review of Vijayakanthi et al…”

Section: Discussionsupporting

confidence: 92%

BMI predicts exercise induced bronchoconstriction in asthmatic boys

et al. 2017

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Section: Discussionsupporting

confidence: 92%

BMI predicts exercise induced bronchoconstriction in asthmatic boys

et al. 2017

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“…[46][47][48][49][50] The practical consequence is that OSA should be excluded in DA and STRA (testing depending on the level of suspicion), and treated if present on its merits. Whether treatment of OSA will be beneficial to asthma control will likely vary between individual patients.…”

Section: Obesitymentioning

confidence: 99%

Severe asthma in children

2017

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Most children with asthma have their disease easily controlled if low-dose inhaled corticosteroids (ICSs) are regularly and correctly administered. If a child presents with asthma which is apparently resistant to therapy with high-dose ICS and other controllers, then they have problematic severe asthma. However, in light of the UK National Review of Asthma Deaths, definitions of severe asthma based solely on the levels of prescribed treatment are too narrow. A detailed assessment of all such children should be performed. First, the diagnosis of asthma should be confirmed, then co-morbidities assessed. Next, a nurse-led assessment further characterizes the problem, conventionally categorizing the child as either having difficult asthma or severe therapy-resistant asthma. Here, we reassess in particular the interactions between, and management of, these two categories, highlighting that this dichotomous classification may need reconsideration. We use bronchoscopy and an intramuscular steroid injection to determine if the child has steroid-resistant asthma, using a novel, multidomain approach because the adult definition does not apply to around half the children we see. Finally, we highlight some mechanistic data which have emerged from this protocol such as the absence of T-helper 2 (TH2) cytokines even in eosinophilic severe asthma and the potential role of the innate epithelial cytokine IL-33, novel data on lineage negative innate lymphoid cells, which we can measure in induced sputum, and demonstrating that intraepithelial neutrophils are associated with better, not worse asthma outcomes. Severe paediatric asthma is very different from severe asthma in adults, and approaches must not be uncritically extrapolated from adult disease to children.

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“…For example, obesity has been implicated in OSA even after adenotonsillectomy, 6 as well as in the development of asthma. 7 A bidirectional association between asthma and OSA has also been described, thought in part to be secondary to increased vagal tone and inflammation leading to increased airway resistance. 8 Although there is extensive insight into these individual relationships, little is known about how all three comorbid conditions may interact.…”

Section: Introductionmentioning

confidence: 99%

Asthma and obesity as predictors of severe obstructive sleep apnea in an adolescent pediatric population

et al. 2019

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Objective To study a cohort of children referred for full‐night polysomnography (PSG) due to suspicion of obstructive sleep apnea (OSA). We examined the relationship between asthma, obesity, and severe OSA (sOSA). Methods We performed a retrospective case control analysis of children, ages 9 to 17 years, who underwent full‐night PSG. The primary goal was to determine the association between asthma, obesity, and sOSA (apnea‐hypopnea index ≥10). We used multiple logistic regression analysis to estimate these associations after controlling for covariates. A P value of ≤.05 was considered significant. Results The study included 367 children (mean [standard deviation] age 14 years (1.7), 56% male, 43% Hispanic). The prevalence of asthma was 188 of 367 (52%); obesity was 197 of 367 (54%); and sOSA was 109 of 367 (30%). sOSA was less likely in asthmatics (coefficient = −0.59; standard error [SE] = 0.23; P = .01; odds ratio [OR] = 0.55; 95% confidence interval [CI] = 0.34 to 0.88) and more likely with obesity (coefficient = 0.89; SE = 0.24; P < .001; OR = 2.4; 95% CI = 1.5 to 3.9). The presence of asthma reduced the likelihood of sOSA by an average of 14% among obese patients and 9% among nonobese patients. These associations held even after controlling for age, sex, race, income, and tonsillar hypertrophy. Conclusion The presence of asthma reduced, whereas obesity increased the likelihood of sOSA among a large cohort of older children referred for PSG. These relationships were additive. Further research is indicated regarding these relationships. Level of Evidence 3b Laryngoscope, 130:812–817, 2020

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Pediatric Obesity-Related Asthma: The Role of Metabolic Dysregulation

Cited by 76 publications

References 155 publications

BMI predicts exercise induced bronchoconstriction in asthmatic boys

BMI predicts exercise induced bronchoconstriction in asthmatic boys

Severe asthma in children

Asthma and obesity as predictors of severe obstructive sleep apnea in an adolescent pediatric population

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