Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids

National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet

Research output: Contribution to journalArticle

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Abstract

Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.

Original languageEnglish (US)
Pages (from-to)1459-1467.e2
JournalJournal of Allergy and Clinical Immunology
Volume141
Issue number4
DOIs
StatePublished - Apr 2018
Externally publishedYes

Fingerprint

Preschool Children
Adrenal Cortex Hormones
Asthma
Obesity
Body Mass Index
Weights and Measures
Placebos
Pediatric Obesity
Multicenter Studies
Linear Models

Keywords

  • Asthma
  • children
  • exacerbation
  • infants
  • obesity
  • overweight

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids. / National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet.

In: Journal of Allergy and Clinical Immunology, Vol. 141, No. 4, 04.2018, p. 1459-1467.e2.

Research output: Contribution to journalArticle

National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet. / Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids. In: Journal of Allergy and Clinical Immunology. 2018 ; Vol. 141, No. 4. pp. 1459-1467.e2.
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title = "Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids",
abstract = "Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.",
keywords = "Asthma, children, exacerbation, infants, obesity, overweight",
author = "{National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet} and Lang, {Jason E.} and Fitzpatrick, {Anne M.} and Mauger, {David T.} and Guilbert, {Theresa W.} and Jackson, {Daniel J.} and Lemanske, {Robert F.} and Martinez, {Fernando D.} and Strunk, {Robert C.} and Zeiger, {Robert S.} and Wanda Phipatanakul and Bacharier, {Leonard B.} and Pongracic, {Jacqueline A.} and Fernando Holguin and Cabana, {Michael D.} and Covar, {Ronina A.} and Raissy, {Hengameh H.} and Monica Tang and Szefler, {Stanley J.}",
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AU - National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet

AU - Lang, Jason E.

AU - Fitzpatrick, Anne M.

AU - Mauger, David T.

AU - Guilbert, Theresa W.

AU - Jackson, Daniel J.

AU - Lemanske, Robert F.

AU - Martinez, Fernando D.

AU - Strunk, Robert C.

AU - Zeiger, Robert S.

AU - Phipatanakul, Wanda

AU - Bacharier, Leonard B.

AU - Pongracic, Jacqueline A.

AU - Holguin, Fernando

AU - Cabana, Michael D.

AU - Covar, Ronina A.

AU - Raissy, Hengameh H.

AU - Tang, Monica

AU - Szefler, Stanley J.

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N2 - Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.

AB - Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.

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KW - infants

KW - obesity

KW - overweight

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