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Sharma H, Liu A, Rahman MA, Poulton A, Bhurawala H. Documentation and management of paediatric obesity: Evidence from a paediatric inpatient unit. Obes Res Clin Pract 2024; 18:235-237. [PMID: 38760262 DOI: 10.1016/j.orcp.2024.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 03/27/2024] [Accepted: 04/23/2024] [Indexed: 05/19/2024]
Abstract
INTRODUCTION The obesity epidemic is a worldwide phenomenon.1 In Australia, the prevalence of paediatric overweight or obesity is 25%.2 Children with obesity present to medical services more frequently than children with a healthy weight.3 Therefore, any hospital admission is an opportunity for clinicians to identify and manage children with overweight or obesity. Previous research has not objectively measured how frequently clinicians document a child as being above the healthy weight range and initiate weight management strategies. This study addresses this gap in the literature by demonstrating the prevalence rate and clinical characteristics of children with overweight/obesity in a non-tertiary paediatric inpatient unit and measuring the rate of clinician recognition, documentation, and initiation of weight management strategies.
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Affiliation(s)
- Hemani Sharma
- Department of Paediatrics, Nepean Hospital, Derby St, Kingswood, NSW 2750, Australia.
| | - Anthony Liu
- Department of Paediatrics, Nepean Hospital, Derby St, Kingswood, NSW 2750, Australia; Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Derby St, Kingswood, NSW 2750, Australia.
| | | | - Alison Poulton
- Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Derby St, Kingswood, NSW 2750, Australia.
| | - Habib Bhurawala
- Department of Paediatrics, Nepean Hospital, Derby St, Kingswood, NSW 2750, Australia; Discipline of Paediatrics, The University of Sydney Nepean Clinical School, Faculty of Medicine and Health, The University of Sydney, Derby St, Kingswood, NSW 2750, Australia; Faculty of Medicine, University of Notre Dame Australia, Sydney, Australia.
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2
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Aziz DA, Bajwa RA, Viquar W, Siddiqui F, Abbas A. Asthma exacerbations and body mass index in children and adolescents: experience from a tertiary care center. Monaldi Arch Chest Dis 2023. [PMID: 37367834 DOI: 10.4081/monaldi.2023.2581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Accepted: 06/08/2023] [Indexed: 06/28/2023] Open
Abstract
The prevalence and incidence of asthma continue to rise globally. Obesity has been identified as a potential risk factor for asthma exacerbations. The association between body mass index (BMI) and asthma is not well studied in some regions. This study aims to investigate the impact of BMI in pediatric asthmatic patients. This retrospective study was conducted at the Aga Khan University Hospital from 2019 to 2022. Children and adolescents with asthma exacerbation were included. The patients were classified into four groups based on their BMI: underweight, healthy weight, overweight, and obese. The demographic characteristics, medications used, predicted FEV1 measurements, asthma exacerbations per year, length of stay per admission, and the number of patients requiring High Dependency Unit (HDU) care were recorded and analyzed. Our results demonstrated that patients in the healthy weight category had the highest percentage of FEV1 (91.46±8.58) and FEV1/FVC (85.75±9.23) (p<0.001). The study found a significant difference in the average number of asthma exacerbations per year between the four groups. Obese patients had the highest number of episodes (3.22±0.94), followed by the underweight group (2.42±0.59) (p<0.01). The length of stay per admission was significantly shorter for patients with a healthy weight (2.0±0.81), and there was a statistically significant difference observed in the number of patients requiring HDU care among the four groups, as well as in the average length of stay at the HDU (p<0.001). Elevated BMI is related to an increased number of annual asthma exacerbations, a low FEV1 and FEV1/FVC, increased length of stay at admission, and increased stay in the HDU.
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Affiliation(s)
- Danish Abdul Aziz
- Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi.
| | | | | | | | - Aiza Abbas
- Medical College, Aga Khan University, Karachi.
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3
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Andrenacci B, Ferrante G, Roberto G, Piacentini G, La Grutta S, Marseglia GL, Licari A. Challenges in uncontrolled asthma in pediatrics: important considerations for the clinician. Expert Rev Clin Immunol 2022; 18:807-821. [PMID: 35730635 DOI: 10.1080/1744666x.2022.2093187] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION Despite symptoms control being the primary focus of asthma management according to guidelines, uncontrolled asthma is still an issue worldwide, leading to huge costs and asthma deaths at all ages. In childhood, poor asthma control can be even more harmful, as it can irreversibly compromise the children's lung function and the whole family's well-being. AREAS COVERED Given the problem extent, this review aims to discuss the leading modifiable causes of uncontrolled asthma in Pediatrics, giving some practical insights regarding the critical role of families and the main tools for monitoring control and drug adherence, even at a distance. The most recent GINA documents were used as the primary reference, along with the latest evidence regarding the management of asthma control and the impact of the COVID-19 pandemic on asthma. EXPERT OPINION In managing pediatric asthma, a multidisciplinary, multi-determinant, personalized approach is needed, actively involving families, schools, and other specialists. In addition to current strategies for implementing control, electronic health strategies, new validated asthma control tools, and the identification of novel inflammatory biomarkers could lead to increasingly tailored therapies with greater effectiveness in reaching asthma control.
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Affiliation(s)
- Beatrice Andrenacci
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giuliana Ferrante
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Giulia Roberto
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy
| | - Giorgio Piacentini
- Department of Surgical Sciences, Dentistry, Gynaecology and Paediatrics, Pediatric Division, University of Verona, Verona, Italy
| | - Stefania La Grutta
- Institute of Translational Pharmacology, National Research Council, Palermo, Italy
| | - Gian Luigi Marseglia
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Amelia Licari
- Pediatric Unit, Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy.,Pediatric Clinic, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
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Goldberg S, Picard E, Joseph L, Kedem R, Sommer A, Tzur D, Cohen S. Factors associated with resolution of childhood asthma by the age of 17: Large cohort analysis. Pediatr Pulmonol 2022; 57:878-884. [PMID: 35029064 PMCID: PMC9306541 DOI: 10.1002/ppul.25828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 11/09/2021] [Accepted: 01/12/2022] [Indexed: 11/08/2022]
Abstract
BACKGROUND Many children with asthma will become asymptomatic during adolescence. In this study, we evaluated factors associated with recovery from asthma by the age of 17. METHODS The medical records of 17-year-old conscripts to the Israeli army with asthma were compared with the records of conscripts with rigorously diagnosed resolved asthma. We assessed the association between the following parameters and asthma resolution: body mass index (BMI), recurrent rhinitis, birth season, socioeconomic level, and cognition. RESULTS Sixty-eight thousand and ninety conscripts with active asthma were compared to 14,695 with resolved asthma. In univariate analysis, rhinitis, overweight, underweight, higher socioeconomic level, and lower cognitive score were associated with active asthma (p < 0.001 for both sexes), but not the season of birth. In multivariate analysis, only overweight, underweight, rhinitis, and lower cognitive score (p < 0.001 for both sexes) remained significantly associated with persistence of asthma. CONCLUSIONS Although association does not prove causation, our finding is another reason to encourage adolescents with asthma to maintain a normal body weight. Prospective interventional studies are needed in order to decide whether changing weight to ensure BMI is within the ideal range and controlling rhinitis increases the odds of resolution of asthma in adolescence.
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Affiliation(s)
- Shmuel Goldberg
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Elie Picard
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Leon Joseph
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Ron Kedem
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Adir Sommer
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Dorit Tzur
- Medical Corps, Israel Defense Forces, Tel Hashomer, Israel
| | - Shlomo Cohen
- Institute of Pediatric Pulmonary Medicine, Shaare Zedek Medical Center, Jerusalem, Israel
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Persistent overweight or obesity, lung function, and asthma exacerbations in Puerto Rican youth. Ann Allergy Asthma Immunol 2022; 128:408-413.e2. [PMID: 35017083 PMCID: PMC8977258 DOI: 10.1016/j.anai.2022.01.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Revised: 12/27/2021] [Accepted: 01/04/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Whether persistent overweight or obesity affects lung function or asthma morbidity in youth is unclear. OBJECTIVE To evaluate overweight or obesity that persists between school age and adolescence and change in lung function and total immunoglobulin (Ig)E and severe asthma exacerbations in Puerto Rican youth. METHODS Prospective study of 340 Puerto Rican youth assessed at 2 visits, the first at ages 6 to 14 years and the second at ages 9 to 20 years. Persistent overweight or obesity was defined as a body mass index z-score greater than or equal to 85th percentile at both visits. Outcomes of interest were change in percent predicted (%pred) lung function measures and total IgE between study visits and severe asthma exacerbations in the year before visit 2. Logistic or linear regression was used for multivariable analysis. RESULTS In multivariable analysis, persistently overweight or obese subjects had changes in %pred forced expiratory volume in 1 second (FEV1) (β = -5.07%; 95% confidence interval, -1.51% to -8.62%; P < .01) and %pred FEV1 to forced vital capacity (FVC) ratio (β = -2.85%; 95% confidence interval, -0.18% to -5.51%; P = .04) which were lower than those observed in subjects with normal weight at both study visits (control subjects). Compared with control subjects, those who were persistently overweight or obese and those who became overweight or obese at visit 2 had increased odds of more than or equal to 1 severe asthma exacerbation in the year before visit 2. There was no significant association between persistent overweight or obesity and change in %pred FVC or total IgE (P > .20 for both instances). CONCLUSION In a prospective study of Puerto Rican youth, persistently overweight or obese subjects had lower changes in FEV1 or FEV1 to FVC ratio and higher odds of severe asthma exacerbations than subjects of normal weight.
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Halvorson EE, Saha A, Forrest CB, Razzaghi H, Rao S, Phan TLT, Magnusen B, Mejias A, McCrory MC, Wells BJ, Skelton JA, Poehling KA, Tieder JS. Weight Status and Risk of Inpatient Admission for Children With Lower Respiratory Tract Disease. Hosp Pediatr 2021; 11:hpeds.2021-005975. [PMID: 34808672 DOI: 10.1542/hpeds.2021-005975] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To identify associations between weight category and hospital admission for lower respiratory tract disease (LRTD), defined as asthma, community-acquired pneumonia, viral pneumonia, or bronchiolitis, among children evaluated in pediatric emergency departments (PEDs). METHODS We performed a retrospective cohort study of children 2 to <18 years of age evaluated in the PED at 6 children's hospitals within the PEDSnet clinical research network from 2009 to 2019. BMI percentile of children was classified as underweight, healthy weight, overweight, and class 1, 2, or 3 obesity. Children with complex chronic conditions were excluded. Mixed-effects multivariable logistic regression was used to assess associations between BMI categories and hospitalization or 7- and 30-day PED revisits, adjusted for covariates (age, sex, race and ethnicity, and payer). RESULTS Among 107 446 children with 218 180 PED evaluations for LRTD, 4.5% had underweight, 56.4% had healthy normal weight, 16.1% had overweight, 14.6% had class 1 obesity, 5.5% had class 2 obesity, and 3.0% had class 3 obesity. Underweight was associated with increased risk of hospital admission compared with normal weight (odds ratio [OR] 1.76; 95% confidence interval [CI] 1.69-1.84). Overweight (OR 0.87; 95% CI 0.85-0.90), class 1 obesity (OR 0.88; 95% CI 0.85-0.91), and class 2 obesity (OR 0.91; 95% CI 0.87-0.96) had negative associations with hospital admission. Class 1 and class 2, but not class 3, obesity had small positive associations with 7- and 30-day PED revisits. CONCLUSIONS We found an inverse relationship between patient weight category and risk for hospital admission in children evaluated in the PED for LRTD.
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Affiliation(s)
| | | | - Christopher B Forrest
- Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Hanieh Razzaghi
- Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Suchitra Rao
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Thao-Ly Tam Phan
- Department of Pediatrics, Nemours Children's Health System, Wilmington, Delaware
| | - Brianna Magnusen
- Institute for Informatics, School of Medicine, Washington University in St Louis, St Louis, Missouri
| | - Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | | | | | - Joseph A Skelton
- Departments of Pediatrics
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Katherine A Poehling
- Departments of Pediatrics
- Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Joel S Tieder
- Department of Pediatrics, University of Washington and Seattle Children's Hospital, Seattle, Washington
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Parental Feeding, Child Eating and Physical Activity: Differences in Children Living with and without Asthma. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073452. [PMID: 33810395 PMCID: PMC8036624 DOI: 10.3390/ijerph18073452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/18/2021] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
This study aimed to establish the differences in parental attitudes toward feeding and activity, as well as child eating and activity levels, between families of children living with and without asthma. Parents of children and young people aged between 10 and 16 years living both with asthma (n = 310) and without asthma (n = 311) completed measures for parental feeding, parental attitudes toward child exercise, child eating, child activity level and asthma control. Children living with asthma had a significantly higher BMIz (BMI standardised for weight and age) score, were significantly more likely to emotionally overeat and desired to drink more than their peers without asthma. Parents of children with asthma reported greater use of food to regulate emotions, restriction of food for weight control, monitoring of child activity, pressure to exercise and control over child activity. When asthma symptoms were controlled, parental restriction of food for weight management predicted greater child BMIz scores, and higher child activity predicted lower child BMIz scores. These relationships were not found to be significant for children with inadequately controlled asthma. Differences in parental attitudes toward feeding and exercise, and child eating and exercise behaviors, between families may help to explain the increased obesity risk for children with asthma.
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Manivannan S, Chandrasekaran V, Subramanian N. A comparative study of clinical profile and symptom control in overweight and normal weight school-age children with mild persistent asthma. Health Sci Rep 2021; 4:e224. [PMID: 33364442 PMCID: PMC7752164 DOI: 10.1002/hsr2.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 11/10/2020] [Accepted: 11/27/2020] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVES To find out the proportion of children with poor symptom control in overweight/obese and normal weight children with mild persistent asthma and to know the sociodemographic and clinical correlates of poor symptom control in them. MATERIALS AND METHODS Children aged 6 to 12 years with mild persistent asthma with BMI Z score for age and sex more than +1 Z score on WHO BMI Z score chart for age and sex formed the cases. Age- and sex-matched asthmatics with BMI Z score for age and sex between -2 Z and +1 Z score formed the controls. FEV1, FEV1/FVC were measured in both groups using Care Fusion Jaeger spirometer. Symptom control was assessed by ACT score. Statistical analysis was done using SPSS version 19 and Vassarstats. RESULTS The proportion of children with poor control was 19.1% in the overweight/obese group and 23.4% in the normal weight group. There was no significant correlation between BMI and symptom control as assessed by the ACT score. Overweight/obese children with good control showed a slightly lower FEV1/FVC ratio and higher median eosinophil count compared to children with normal weight. Gastroesophageal reflux and allergic rhinitis were more commonly seen in overweight/obese children. In the poor control group, FEV1, FEV1/FVC, and median eosinophil counts were not significantly different between overweight/obese and normal weight group but were less when compared to good control group. CONCLUSION The proportion of poor symptom control was not high in overweight/obese asthmatic children compared to normal weight asthmatic children. No significant risk factors for poor symptom control could be identified in our study for either of the groups.
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Childhood Obesity and Respiratory Diseases: Which Link? CHILDREN-BASEL 2021; 8:children8030177. [PMID: 33669035 PMCID: PMC7996509 DOI: 10.3390/children8030177] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 12/14/2022]
Abstract
Prevalence of childhood obesity is progressively increasing, reaching worldwide levels of 5.6% in girls and of 7.8% in boys. Several evidences showed that obesity is a major preventable risk factor and disease modifier of some respiratory conditions such as asthma and Obstructive Sleep Apnea Syndrome (OSAS). Co-occurrence of asthma and obesity may be due to common pathogenetic factors including exposure to air pollutants and tobacco smoking, Western diet, and low Vitamin D levels. Lung growth and dysanapsis phenomenon in asthmatic obese children play a role in impaired respiratory function which appears to be different than in adults. Genes involved in both asthma and obesity have been identified, though a gene-by-environment interaction has not been properly investigated yet. The identification of modifiable environmental factors influencing gene expression through epigenetic mechanisms may change the natural history of both diseases. Another important pediatric respiratory condition associated with obesity is Sleep-Disordered Breathing (SDB), especially Obstructive Sleep Apnea Syndrome (OSAS). OSAS and obesity are linked by a bidirectional causality, where the effects of one affect the other. The factors most involved in the association between OSAS and obesity are oxidative stress, systemic inflammation, and gut microbiota. In OSAS pathogenesis, obesity's role appears to be mainly due to mechanical factors leading to an increase of respiratory work at night-time. However, a causal link between obesity-related inflammatory state and OSAS pathogenesis still needs to be properly confirmed. To prevent obesity and its complications, family education and precocious lifestyle changes are critical. A healthy diet may lead to an improved quality of life in obese children suffering from respiratory diseases. The present review aimed to investigate the links between obesity, asthma and OSAS, focusing on the available evidence and looking for future research fields.
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Shantakumar S, Ho YF, Beale J, Gribben B. Characterization and burden of severe eosinophilic asthma in New Zealand: Results from the HealthStat Database. Multidiscip Respir Med 2020; 15:662. [PMID: 32983453 PMCID: PMC7460659 DOI: 10.4081/mrm.2020.662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Accepted: 06/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background This retrospective cohort study aimed to characterize epidemiology, medication use and healthcare resource utilization (HCRU) of patients diagnosed with severe eosinophilic asthma (SEA) compared to other patients with asthma in New Zealand. Methods Adult patients with asthma with no concurrent diagnosis of Chronic Obstructive Lung Disease (COPD) were identified from the HealthStat primary care database and the National Minimum Dataset using asthma diagnosis, hospital codes and prescriptions. Patients with SEA were identified using a 1-year baseline period (2011) and were those with: inhaled corticosteroid prescription above medium dose (including high dose) plus controller medication, ≥2 exacerbations, and eosinophils ≥300 cells/μl (or ≥150 in 6 weeks prior to index date); patients were followed for 1 year (2012). Results 160/3,276 (4.9%) asthmatics with available eosinophil counts met SEA criteria. Patients with SEA were more likely to be Māori, former smokers, have more comorbidities, higher mean BMI and higher neutrophil counts compared with other patients with asthma. In the follow up period, SEA patients had over 4 times as many exacerbations; incidence of exacerbations of the same frequency was highest in Māori patients. Conclusions Compared with other patients with asthma, SEA patients had over 1.5 times as many respiratory treatment prescriptions and higher all-cause HCRU and total healthcare costs; asthma-related healthcare costs were 3.6 times greater.
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Affiliation(s)
- Sumitra Shantakumar
- Department of Real World Evidence and Epidemiology, GlaxoSmithKline, GSK Asia House, Singapore
| | - Yu-Fan Ho
- Department of Real World Evidence and Epidemiology, GlaxoSmithKline, GSK Asia House, Singapore
| | - Janine Beale
- Department of Medical Affairs, GlaxoSmithKline, GSK Auckland, New Zealand
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Mensink-Bout SM, Santos S, van Meel ER, Oei EHG, de Jongste JC, Jaddoe VWV, Duijts L. General and Organ Fat Assessed by Magnetic Resonance Imaging and Respiratory Outcomes in Childhood. Am J Respir Crit Care Med 2020; 201:348-355. [PMID: 31597047 DOI: 10.1164/rccm.201905-0942oc] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Rationale: Obesity has been implicated as a pathogenic factor in asthma, but the underlying role of general and organ fat is unclear.Objectives: We hypothesized that organ fat, rather than the total fat mass, increases the risk of asthma.Methods: In a population-based prospective cohort study among 5,421 children aged 10 years, we measured general fat including body mass index and fat mass index by dual-energy X-ray absorptiometry, and organ fat including subcutaneous fat index, visceral fat index, pericardial fat index, and liver fat fraction by magnetic resonance imaging. Lung function was measured by spirometry. Current asthma was assessed by questionnaire.Measurements and Main Results: Higher body mass index and fat mass index were associated with higher FEV1 (z-score difference [95% confidence interval (CI)], 0.16 [0.14 to 0.19] and z-score difference [95% CI], 0.06 [0.03 to 0.09] per SD score increase, respectively), higher FVC (z-score difference [95% CI], 0.19 [0.17 to 0.22] and z-score difference [95% CI], 0.07 [0.04 to 0.10]), and lower FEV1/FVC ratio (z-score difference [95% CI], -0.07 [-0.10 to -0.05] and z-score difference [95% CI], -0.03 [-0.06 to -0.00]) but not with forced expiratory flow after exhaling 75% of FVC or asthma. Higher visceral fat index, independent of fat mass index, was associated with higher FVC (z-score difference [95% CI], 0.07 [0.03 to 0.10]), lower FEV1/FVC (z-score difference [95% CI], -0.05 [-0.09 to -0.01]), and higher risk of asthma (odds ratio, 1.20; 95% CI, 1.01 to 1.43 per SD score increase). No other organ fat measures were independently associated with lung function or asthma.Conclusions: The obesity-asthma link is driven mainly by visceral fat, independent of total fat mass; therefore, abdominal fat might contribute to asthma development.
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Affiliation(s)
- Sara M Mensink-Bout
- The Generation R Study Group.,Division of Respiratory Medicine and Allergology and
| | - Susana Santos
- The Generation R Study Group.,Department of Pediatrics, and
| | - Evelien R van Meel
- The Generation R Study Group.,Division of Respiratory Medicine and Allergology and
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, University Medical Center, Rotterdam, the Netherlands
| | | | | | - Liesbeth Duijts
- Division of Respiratory Medicine and Allergology and.,Division of Neonatology
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Abstract
PURPOSE OF REVIEW Asthma is a common chronic disease of the airways characterized by recurrent respiratory symptoms, bronchoreactivity, and airway inflammation. The high toll on quality of life has led to sustained efforts to understand the factors leading to asthma inception and poor disease control. Obesity is another increasingly common pediatric disease, which appears to increase the risk for incident asthma and worsened disease severity. Currently, our understanding of how obesity affects asthma risk and affects its phenotypic characteristics remains incomplete. The current review describes our current understanding of the epidemiology, clinical characteristics, and management considerations of obesity-related asthma in children. RECENT FINDINGS The epidemiologic relationship between obesity in children and incident asthma remains confusing despite numerous longitudinal cohort studies, and appears to be influenced by early life exposures, patterns of somatic growth and underlying familial risks of allergic disease. Children with comorbid obesity and asthma demonstrate diverse phenotypic characteristics which are still becoming clear. SUMMARY Like any child with asthma, a child with comorbid obesity requires an individualized approach adhering to current best-practice guidelines and an understanding of how obesity and asthma may interact.
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Excessive Body Weight and Immunological Response in Children with Allergic Diseases. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2019; 1211:77-87. [PMID: 31456043 DOI: 10.1007/5584_2019_426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
The prevalence of allergy and obesity is sharply on the rise in children. However, the nature of a mutual relation of the two conditions remains unclear. The aim of the study was to assess the impact of excessive body weight on the immune response in children with allergies. There were 56 children with allergies, aged 4-15 years, included into the study (41 with asthma and 15 with atopic dermatitis). Based on the body mass index, children were divided into two groups: normal weight (body mass index (BMI) <85th percentile) and excessive weight (BMI ≥ 85th percentile). The immunological parameters were evaluated by flow cytometry. We found that children with excessive body weight had a significantly lower percentage of CD4+ lymphocytes and a higher percentage of natural killer T cells (NKT) and CD16/56+ lymphocytes than those with normal weight. In the group with allergy, a significant positive association was noticed between BMI and the percentage of human leukocyte antigen (HLA)-DR-specific CD3. Further analysis was done after dividing the allergy group into the children with normal and excessive weight. There were an adverse association between BMI and the percentage of CD8+ lymphocytes in those with normal weight and a positive one between BMI and the percentage of CD4+ in those with excessive weight. We conclude that excessive body weight plays a major role in mediating the immunological response in children with allergy.
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14
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Schuler CL, Biagini Myers JM, Kercsmar CM, Pilipenko VV, Kroner JW, Simmons JM, Austin SR, Gunkelman SM, Ross KR, McCoy KS, Kalra M, Ruddy JR, Martin LJ, Khurana Hershey GK. Weighing in on asthma: Insights on BMI, magnesium, and hospitalizations from the Ohio Pediatric Asthma Repository. J Asthma 2019; 57:1280-1287. [PMID: 31411907 DOI: 10.1080/02770903.2019.1652639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective: Little is known about weight status and its effects on clinical course during hospitalization for asthma exacerbation. We sought to evaluate associations between weight status, specifically body mass index (BMI), with inpatient clinical course and clinical history.Methods: We retrospectively analyzed data from 2012 to 2013 on children hospitalized for asthma exacerbation in a state-wide longitudinal cohort, the Ohio Pediatric Asthma Repository. We examined BMI continuously (z scores) and categorically, comparing overweight and obese (Ov/Ob) to non-overweight and non-obese (nOv/nOb) children. We used linear mixed models controlling for site effects to determine if BMI was related to length of stay, as determined by physiologic readiness for discharge (PRD), defined as time to albuterol spaced every 4 h, need for nonstandard care or clinical history.Results: Across six hospitals, 874 children were included in analyses. BMI was positively associated with PRD (p=.008) but this increase was unlikely to be clinically significant. Ov/Ob children were more likely than nOv/nOb to require nonstandard care with repeat magnesium dosing in intensive care after dosing in the emergency department (OR = 3.23, 95%CI 1.39-7.78). Hospitalization in the year prior to enrollment was positively associated with BMI percentile (73.3 vs. 66.0, p=.028). Sleep disordered breathing was also associated with higher BMI percentile (78.2 vs. 65.9; p=.0013).Conclusions: Ov/Ob children had similar PRD to nOv/nOb children and were prone to repeat magnesium dosing. Previous hospitalization for exacerbation was positively associated with increasing BMI percentile. Additional research should investigate differential magnesium use by weight status, quantifying risks and benefits.
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Affiliation(s)
- Christine L Schuler
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Jocelyn M Biagini Myers
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Carolyn M Kercsmar
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Valentina V Pilipenko
- Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - John W Kroner
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jeffrey M Simmons
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Stephen R Austin
- Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Samantha M Gunkelman
- Division of Pediatric Hospital Medicine, Akron Children's Hospital, Akron, OH, USA
| | - Kristie R Ross
- Department of Pediatrics-Pulmonary, Rainbow Babies and Children's Hospital, Cleveland, OH, USA
| | - Karen S McCoy
- Division of Pediatric Pulmonology, Nationwide Children's Hospital, Columbus, OH, USA
| | - Maninder Kalra
- Department of Pulmonary Medicine, Dayton Children's Hospital, Dayton, OH, USA
| | - Jennifer R Ruddy
- Department of Pediatric Pulmonary Medicine, ProMedica Toledo Children's Hospital, Toledo, OH, USA
| | - Lisa J Martin
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Human Genetics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Gurjit K Khurana Hershey
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA.,Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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15
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Morphew T, Galant SP. Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile. Ann Allergy Asthma Immunol 2018; 122:167-174. [PMID: 30394336 DOI: 10.1016/j.anai.2018.10.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 10/21/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Obesity is thought to be associated with poor asthma control, increased health resource utilization, and reduced responsiveness to inhaled corticosteroids. OBJECTIVE Based on previous experience, our hypothesis was that by improved access to comprehensive guideline care, outcomes in normal weight would be comparable in obese children with asthma. METHODS This was a retrospective cohort study of predominately Hispanic children (3-18 years of age) in underserved areas of Orange County, California, who enrolled in the Breathmobile Program from 2003 to 2012. Outcomes were examined by using Cox regression and generalized estimating equations analyses, adjusted for potential confounding factors. RESULTS Clinical outcomes in more than 1,200 children followed up for a mean of 6 visits (standard deviation [SD] = 2.2) across 403 days (SD = 112) were improved, on average, regardless of body mass index (BMI). Morbidly obese (MOB) patients were able to achieve significant reductions of approximately 60% or more in report of emergency department (ED) visits, hospitalizations, school absenteeism, usual exercise limitations, and exacerbations to levels that were comparable those of normal weight (NW) patients. The importance of close follow-up, particularly for the MOB patient, was evidenced by achieving 80% cumulative probability of well controlled asthma by visit 3, similar to patients in lower BMI risk groups with good adherence, when the visit interval did not exceed 90 days. These outcomes were achieved across all BMI groups with similar mean step of therapy, adjusted for severity (P < .001). CONCLUSION Access to effective community-based care where trust, education, and continuity of care consistent with National Asthma Education and Prevention Program (NAEPP) guidelines is possible, as demonstrated by the Breathmobile Program, can provide an opportunity for children with asthma in all BMI categories to achieve well-controlled disease.
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Affiliation(s)
- Tricia Morphew
- Morphew Consulting, LLC, Bothell, Washington; Children's Hospital of Orange County, Orange, California.
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16
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Kirkby S, Rossetti A, Hayes D, Allen E, Sheikh S, Kopp B, Patel A. Benefits of pulmonary rehabilitation in pediatric asthma. Pediatr Pulmonol 2018; 53:1014-1017. [PMID: 29736958 DOI: 10.1002/ppul.24041] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 04/17/2018] [Indexed: 11/11/2022]
Abstract
INTRODUCTION There are limited studies evaluating the role of pulmonary rehabilitation (PR) in pediatric asthma. METHODS A retrospective chart review was performed of all pediatric patients with a diagnosis of asthma enrolled in PR. Demographics, medications, and clinical records were reviewed. In addition, PFTs, 6-min walk test (6MWT), and patient/parent symptom and quality of life surveys before and after PR were evaluated. RESULTS A total of 38 patients were enrolled in PR; 18 (47%) female and 20 (53%) male. Mean participant age was 11.33 ± 3.37 (range 4-19) years. Twenty-two (58%) were Caucasian and nine (24%) African American. Chart review was limited by incomplete data sets for many participants. Following PR, significant improvement was noted in mean 6MWT distance (1541 vs 1616 feet, P = 0.05) and FEV1 (89.9% of predicted versus 96.4%, P = 0.04). Survey instruments demonstrated improvement in several clinical factors, however, there was no significant change in weight following PR despite scheduled cardiovascular exercise and dietary counseling. CONCLUSIONS Structured PR for pediatric patients with asthma can improve 6MWT distance and FEV1 as well as subjective measures of SOB and QOL, suggesting a role for PR in the chronic management of pediatric asthma. Further prospective investigation is needed to determine if PR has positive effects on other clinical parameters of asthma control and its overall impact on childhood obesity.
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Affiliation(s)
- Stephen Kirkby
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Allison Rossetti
- Section of General Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio.,Division of Pulmonary, Allergy, Critical Care, and Sleep Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Elizabeth Allen
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Shahid Sheikh
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Benjamin Kopp
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
| | - Alpa Patel
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, Ohio
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17
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Buelo A, McLean S, Julious S, Flores-Kim J, Bush A, Henderson J, Paton JY, Sheikh A, Shields M, Pinnock H. At-risk children with asthma (ARC): a systematic review. Thorax 2018; 73:813-824. [PMID: 29871982 PMCID: PMC6109248 DOI: 10.1136/thoraxjnl-2017-210939] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
Introduction Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care. Methods We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. Results From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. Discussion Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. Trial registration number CRD42016037464.
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Affiliation(s)
- Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Susannah McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Steven Julious
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
| | - Javier Flores-Kim
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Andy Bush
- Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University, Belfast, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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18
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Rastogi D, Nico J, Johnston AD, Tobias TAM, Jorge Y, Macian F, Greally JM. CDC42-related genes are upregulated in helper T cells from obese asthmatic children. J Allergy Clin Immunol 2018; 141:539-548.e7. [PMID: 28479334 PMCID: PMC5671374 DOI: 10.1016/j.jaci.2017.04.016] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 04/04/2017] [Accepted: 04/18/2017] [Indexed: 01/21/2023]
Abstract
BACKGROUND Pediatric obesity-related asthma is more severe and less responsive to medications than asthma in normal-weight children. Obese asthmatic children have nonatopic TH1-polarized systemic inflammation that correlates with pulmonary function deficits, but the pathways underlying TH1-polarized inflammation are not well understood. OBJECTIVE We compared the CD4+ T-cell transcriptome in obese children with asthma with that in normal-weight children with asthma to identify key differentially expressed genes associated with TH1-polarized inflammation. METHODS CD4+ T-cell transcriptome-wide differential gene expression was compared between 21 obese and 21 normal-weight children by using directional RNA sequencing. High-confidence differentially expressed genes were verified in the first cohort and validated in a second cohort of 20 children (10 obese and 10 normal-weight children) by using quantitative RT-PCR. RESULTS Transcriptome-wide differential gene expression among obese asthmatic children was enriched for genes, including VAV2, DOCK5, PAK3, PLD1, CDC42EP4, and CDC42PBB, which are associated with CDC42, a small guanosine triphosphate protein linked to T-cell activation. Upregulation of MLK3 and PLD1, genes downstream of CDC42 in the mitogen-activated protein kinase and mammalian target of rapamycin pathways and the inverse correlation of CDC42EP4 and DOCK5 transcript counts with FEV1/FVC ratio together support a role of CDC42 in the TH1 polarization and pulmonary function deficits found in patients with obesity-related asthma. CONCLUSIONS Our study identifies the CDC42 pathway as a novel target that is upregulated in TH cells of obese asthmatic children, suggesting its role in nonatopic TH1-polarized systemic inflammation and pulmonary function deficits found in patients with pediatric obesity-related asthma.
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Affiliation(s)
- Deepa Rastogi
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY.
| | - John Nico
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Andrew D Johnston
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY
| | | | - Yurydia Jorge
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, NY
| | - Fernando Macian
- Department of Pathology, Albert Einstein College of Medicine, Bronx, NY
| | - John M Greally
- Department of Genetics, Albert Einstein College of Medicine, Bronx, NY
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19
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The obese-asthma phenotype in children: An exacerbating situation? J Allergy Clin Immunol 2018; 141:1239-1249.e4. [PMID: 29382592 DOI: 10.1016/j.jaci.2017.10.052] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 09/28/2017] [Accepted: 10/04/2017] [Indexed: 11/23/2022]
Abstract
BACKGROUND Current evidence regarding the relationship between childhood obesity, decreased response to inhaled corticosteroids (ICSs), and poor asthma control is conflicting. OBJECTIVES We assessed whether obesity (1) is associated with time to first exacerbation among children with asthma initiating step 3 maintenance therapies and (2) modifies the effectiveness of step 3 therapies. METHODS A retrospective cohort study was conducted from clinical data linked to health and drug administrative databases. The cohort consisted of children aged 2 to 18 years with specialist-confirmed asthma who initiated medium/high-dose ICS monotherapy or low/medium-dose ICS with leukotriene receptor antagonist/long-acting β-agonist (combination therapy) at the Montreal Children's Hospital Asthma Center from 2000 to 2007. Children were classified as exposed to step 3 therapies when they were dispensed a corresponding drug claim during follow-up, whereas those without claims were classified as nonadherers. Marginal structural Cox models were used to estimate the effect of obesity (body mass index > 97th percentile) and treatment on time to exacerbation, which was defined as any emergency department visit, hospitalization, or use of oral corticosteroids for asthma. RESULTS Of the 4621 cohort patients, 231 initiated ICS monotherapy, and 97 initiated combination therapy. The hazard ratio (HR) for obesity was 1.67 (95% CI, 1.41-1.98). Compared with nonobese nonadherers, the HR for obese nonadherers was 1.54 (95% CI, 0.97-2.45); the HR for ICS monotherapy in obese and nonobese children was 0.85 (95% CI, 0.47-1.52) and 0.58 (95% CI, 0.37-0.91), respectively; and the HR for combination therapy in obese and nonobese children was 0.50 (95% CI, 0.13-1.89) and 0.46 (95% CI, 0.23-0.92), respectively. CONCLUSION Obesity might be a determinant of shorter exacerbation-free time in children with asthma; however, we could not rule out a differential response to step 3 therapies by obesity status, potentially because of a lack of precision.
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20
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Lang JE, Fitzpatrick AM, Mauger DT, Guilbert TW, Jackson DJ, Lemanske RF, Martinez FD, Strunk RC, Zeiger RS, Phipatanakul W, Bacharier LB, Pongracic JA, Holguin F, Cabana MD, Covar RA, Raissy HH, Tang M, Szefler SJ. Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids. J Allergy Clin Immunol 2017; 141:1459-1467.e2. [PMID: 29273557 PMCID: PMC6675020 DOI: 10.1016/j.jaci.2017.09.043] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2017] [Revised: 08/31/2017] [Accepted: 09/27/2017] [Indexed: 02/06/2023]
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.
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Affiliation(s)
- Jason E Lang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC.
| | | | - David T Mauger
- Department of Public Health Sciences, College of Medicine, Penn State University, Hershey, Pa
| | | | - Daniel J Jackson
- Pediatrics Section of Allergy, Immunology, and Rheumatology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Robert F Lemanske
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | | | | | - Robert S Zeiger
- Kaiser Permanente Medical Center, University of California-San Diego, San Diego, Calif
| | | | | | | | - Fernando Holguin
- University of Pittsburgh School of Medicine, Pittsburgh, Pittsburgh, Pa
| | | | | | | | - Monica Tang
- Department of Pediatrics, Duke University School of Medicine, Durham, NC
| | - Stanley J Szefler
- Children's Hospital Colorado, The Breathing Institute, and University of Colorado School of Medicine, Aurora, Colo
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21
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Okubo Y, Michihata N, Yoshida K, Morisaki N, Matsui H, Fushimi K, Yasunaga H. Impact of pediatric obesity on acute asthma exacerbation in Japan. Pediatr Allergy Immunol 2017; 28:763-767. [PMID: 29044803 DOI: 10.1111/pai.12801] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/06/2017] [Indexed: 01/24/2023]
Abstract
BACKGROUND Asthma and obesity are common health problems in children. This study investigated the impact of obesity on children hospitalized with acute asthma exacerbation. METHODS We obtained the hospital discharge records of inpatients aged 3-8 years with a diagnosis of asthma using a national inpatient database in Japan. The patients were classified into underweight, normal weight, overweight, and obese groups using weight for height and body mass index for age provided by the World Health Organization. We compared 30-day re-admission, need for intensive care, mean total hospitalization costs, and length of hospital stay between the 4 groups using multivariable regression models. RESULTS Overall, 38 679 patients were identified, including 3177 underweight, 28 904 normal weight, 3334 overweight, and 3264 obese patients. The obese group showed significantly higher 30-day re-admission (adjusted odds ratio, 1.26; 95% confidence interval, 1.03-1.54) and longer length of stay (adjusted difference, 0.12 days; 95% confidence interval, 0.10-0.20 days) than the normal weight group. The threshold was a 91st percentile of weight for length or body mass index for the relationship with 30-day re-admission. No significant difference was observed between the 4 groups regarding the need for intensive care and total hospitalization costs. CONCLUSION These findings demonstrated that obesity was a risk factor for repeated admissions caused by asthma in children, indicating the importance for the prevention of pediatric obesity.
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Affiliation(s)
- Yusuke Okubo
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan.,Department of Epidemiology, UCLA Fielding School of Public Health, Tokyo, Japan
| | - Nobuaki Michihata
- Department of Health Services Research, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Koichi Yoshida
- Division of Allergy, Tokyo Metropolitan Children's Medical Center, Tokyo, Japan
| | - Naho Morisaki
- Department of Social Medicine, National Research Institute for Child Health and Development, Tokyo, Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
| | - Kiyohide Fushimi
- Department of Health Policy and Informatics, Tokyo Medical and Dental University Graduate School of Medicine, Tokyo, Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan
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22
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Harb N, Foster JM, Dobler CC. Patient-perceived treatment burden of chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis 2017; 12:1641-1652. [PMID: 28615937 PMCID: PMC5459974 DOI: 10.2147/copd.s130353] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND While chronic morbidity and mortality from COPD is well documented, little is known about the treatment burden faced by patients with COPD. SUBJECTS AND METHODS Patients with severe airflow obstruction (forced expiratory volume in 1 second [FEV1] <50% predicted) representing different age-groups, sex, and number of comorbidities participated in a semistructured interview. Interviews were conducted until thematic saturation was reached. Interviews were recorded, transcribed, and analyzed thematically using an established treatment-burden framework. RESULTS A total of 26 patients (42% male, mean age 66.7±9.8 years) with severe (n=15) or very severe (n=11) airflow limitation (mean FEV1 32.1%±9.65% predicted) were interviewed. Participants struggled with various treatment-burden domains, predominantly with changing health behaviors, such as smoking cessation and exercise. Interviewees often only ceased smoking after a major health event, despite being advised to do so earlier by a doctor. Recommended exercise regimens, such as pulmonary rehabilitation classes, were curtailed, although some patients replaced them with light home-based exercise. Interviewees had difficulty attending medical appointments, often relying on others to transport them. Overall, COPD patients indicated they were not willing to accept the burden of treatments where they perceived minimal benefit. CONCLUSION This study describes the substantial treatment burden experienced by patients with COPD. Medical advice may be rejected by patients if the benefit of following the advice is perceived as insufficient. Health professionals need to recognize treatment burden as a source of nonadherence, and should tailor treatment discussions to fit patients' values and capacity to achieve optimal patient outcomes.
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Affiliation(s)
- Nathan Harb
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital
| | - Juliet M Foster
- Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
| | - Claudia C Dobler
- South Western Sydney Clinical School, University of New South Wales.,Department of Respiratory Medicine, Liverpool Hospital.,Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia
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23
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Xu XW, Huang Y, Wang J, Zhang XL, Liang FM, Luo R. [Effect of obesity on pulmonary function in asthmatic children of different age groups]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2017; 19:519-523. [PMID: 28506341 PMCID: PMC7389131 DOI: 10.7499/j.issn.1008-8830.2017.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 02/01/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To study the effect of obesity on pulmonary function in newly diagnosed asthmatic children of different age groups. METHODS Two hundred and ninety-four children with newly diagnosed asthma were classified into preschool-age (<6 years) and school-age (6 to 12.5 years) groups. They were then classified into obese, overweight, and normal-weight subgroups based on their body mass index (BMI). All the children underwent pulmonary function tests, including large airway function tests [forced vital capacity (FVC%) and forced expiratory volume in one second (FEV1%)] and small airway function tests [maximal expiratory flow at 25% of vital capacity (MEF25%), maximal expiratory flow at 50% of vital capacity (MEF50%), and maximal expiratory flow at 75% of vital capacity (MEF75%)]. RESULTS The school-age group showed lower FEV1%, MEF25%, and MEF50% than the preschool-age group (P<0.05) after adjustment for sex and BMI. The normal-weight children in the school-age group had lower FEV1%, MEF25%, and MEF50% compared with their counterparts in the preschool-age group (P<0.05). The overweight children in the school-age group showed lower FVC% and MEF50% than those in the preschool-age group. However, all the pulmonary function parameters showed no significant differences between the obese children in the preschool-age and school-age groups. In the preschool-age group, FVC%, FEV1%, and MEF75% of the obese children were lower than those of the normal-weight children. In the school-age group, only FVC% and FEV1% showed differences between the obese and normal-weight children (P<0.05). CONCLUSIONS The effect of obesity on the pulmonary function varies with age in children with asthma, and the effect is more obvious in those of preschool age.
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Affiliation(s)
- Xiao-Wen Xu
- Respiratory Center, Children's Hospital of Chongqing Medical University/ Ministry of Education Key Laboratory of Child Development and Disorders/Chongqing Key Laboratory of Pediatrics/China International Science and Technology Cooperation Base of Child Development and Critical Disorders, Chongqing 400014, China.
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24
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Loman DG, Kwong CG, Henry LD, Mahl C, Meadows L, Ellis AG. Asthma control and obesity in urban African American children. J Asthma 2016; 54:578-583. [PMID: 27753512 DOI: 10.1080/02770903.2016.1244827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To examine the relationship between body mass index (BMI), gender, age, controller medication use, household smoke exposure, season, and allergic rhinitis status with asthma control in a group of lower income, African American children. We hypothesized that non-obese children would have better asthma control. METHODS Baseline data from a longitudinal study of children in a school-based asthma program in a Midwest urban area were analyzed. 360 children, ages 4-15 years, who were enrolled in either the 2012-2013 or 2013-2014 program were included. Asthma control was classified using criteria from the 2007 National Asthma Education and Prevention Program. Multiple ordinal regression was performed. RESULTS The median age was 9 years, 61% had well-controlled asthma, and 29% were obese. The model included all main effects plus two interaction terms and was significant (χ2(7) = 22.17, p =.002). Females who were normal weight (OR, 2.78; 95% CI, 1.38-5.60, p =.004) or overweight (OR, 3.12; 95% CI, 1.26-7.72, p =.014) had better asthma control than obese females. For males, there were no differences by BMI category but males without allergic rhinitis had significantly better asthma control (OR, 2.23; 95% CI, 1.25-3.97, p =.006) than those with allergic rhinitis. CONCLUSIONS Non-obese girls and non-allergic males had better asthma control. Promotion of healthy activity and nutrition as well as management of allergic rhinitis should be part of the asthma plan in school-based programs in low income urban areas. Innovative approaches to address asthma care in low income populations are essential.
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Affiliation(s)
- Deborah G Loman
- a Saint Louis University School of Nursing , St. Louis , Missouri , USA
| | - Christina G Kwong
- b Department of Pediatrics , Washington University School of Medicine , St. Louis , Missouri , USA
| | - Lisa D Henry
- c St. Louis Children's Hospital , St. Louis , Missouri , USA
| | - Christina Mahl
- c St. Louis Children's Hospital , St. Louis , Missouri , USA
| | - Lisa Meadows
- c St. Louis Children's Hospital , St. Louis , Missouri , USA
| | - Alysa G Ellis
- b Department of Pediatrics , Washington University School of Medicine , St. Louis , Missouri , USA
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Ahmadizar F, Vijverberg SJ, Arets HG, de Boer A, Lang JE, Kattan M, Palmer CN, Mukhopadhyay S, Turner S, Maitland-van der Zee AH. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur Respir J 2016; 48:1063-1073. [DOI: 10.1183/13993003.00766-2016] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 06/11/2016] [Indexed: 01/08/2023]
Abstract
To estimate the association between obesity and poor asthma control or risk of exacerbations in asthmatic children and adolescents, and to assess whether these associations are different by sex.A meta-analysis was performed on unpublished data from three North-European paediatric asthma cohorts (BREATHE, PACMAN (Pharmacogenetics of Asthma medication in Children: Medication with Anti-inflammatory effects) and PAGES (Pediatric Asthma Gene Environment Study)) and 11 previously published studies (cross-sectional and longitudinal studies). Outcomes were poor asthma control (based on asthma symptoms) and exacerbations rates (asthma-related visits to the emergency department, asthma-related hospitalisations or use of oral corticosteroids). Overall pooled estimates of the odds ratios were obtained using fixed- or random-effects models.In a meta-analysis of 46 070 asthmatic children and adolescents, obese children (body mass index ≥95th percentile) compared with non-obese peers had a small but significant increased risk of asthma exacerbations (OR 1.17, 95% CI 1.03–1.34; I2: 54.7%). However, there was no statistically significant association between obesity and poor asthma control (n=4973, OR 1.23, 95% CI 0.99–1.53; I2: 0.0%). After stratification for sex, the differences in odds ratios for girls and boys were similar, yet no longer statistically significant.In asthmatic children, obesity is associated with a minor increased risk of asthma exacerbations but not with poor asthma control. Sex does not appear to modify this risk.
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Okubo Y, Nochioka K, Hataya H, Sakakibara H, Terakawa T, Testa M. Burden of Obesity on Pediatric Inpatients with Acute Asthma Exacerbation in the United States. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2016; 4:1227-1231. [PMID: 27372599 DOI: 10.1016/j.jaip.2016.06.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Revised: 05/25/2016] [Accepted: 06/07/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Obesity and asthma are common health problems in the United States. OBJECTIVE The objective of this study was to evaluate the clinical and economic burdens of obesity on hospitalized children with acute asthma exacerbation in 2012. METHODS Hospital discharge records of patients aged 2 to 18 years with a diagnosis of asthma were obtained from the 2012 Kids' Inpatient Database, wherein the data were compiled by the Agency for Healthcare Research and Quality. The discharge records were weighted to estimate the number of hospitalizations because of asthma exacerbations in the United States. To classify whether the patient was obese or not, we used the International Classification of Diseases, Ninth Revision, Clinical Modification code 278.0x. We compared the odds of using noninvasive or invasive mechanical ventilation, mean total charges for inpatient service, and length of hospital stay between obese and nonobese patients. RESULTS A total of 74,338 patient discharges were extracted. Of these, 3,494 discharges were excluded because of chronic medical conditions. Using discharge weight variables, we estimated a total of 100,157 hospitalizations with asthma exacerbations among children aged between 2 and 18 years in 2012. Obesity was significantly associated with higher odds of using mechanical ventilation (odds ratio 1.59, 95% CI 1.28-1.99), higher mean total hospital charges (adjusted difference: $1588, 95% CI $802-$2529), and longer mean length of hospital stay (0.24 days, 95% CI 0.17-0.32 days) compared with nonobesity. CONCLUSIONS These findings suggest that obesity is a significant risk factor of severe asthma exacerbation that requires mechanical ventilation, and obesity is an economically complicating factor.
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Affiliation(s)
- Yusuke Okubo
- Quantitative Methods, Harvard T.H. Chan School of Public Health, Boston, Mass; Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan.
| | - Kotaro Nochioka
- Quantitative Methods, Harvard T.H. Chan School of Public Health, Boston, Mass; Clinical Effectiveness, Harvard T.H. Chan School of Public Health, Boston, Mass
| | - Hiroshi Hataya
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Hiroshi Sakakibara
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Toshiro Terakawa
- Department of General Pediatrics, Tokyo Metropolitan Children's Medical Center, Fuchu, Tokyo, Japan
| | - Marcia Testa
- Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Mass
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Willeboordse M, van de Kant KDG, Tan FES, Mulkens S, Schellings J, Crijns Y, van der Ploeg L, van Schayck CP, Dompeling E. A Multifactorial Weight Reduction Programme for Children with Overweight and Asthma: A Randomized Controlled Trial. PLoS One 2016; 11:e0157158. [PMID: 27294869 PMCID: PMC4905647 DOI: 10.1371/journal.pone.0157158] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2015] [Accepted: 05/24/2016] [Indexed: 11/19/2022] Open
Abstract
Background There is increasing evidence that obesity is related to asthma development and severity. However, it is largely unknown whether weight reduction can influence asthma management, especially in children. Objective To determine the effects of a multifactorial weight reduction intervention on asthma management in overweight/obese children with (a high risk of developing) asthma. Methods An 18-month weight-reduction randomized controlled trial was conducted in 87 children with overweight/obesity and asthma. Every six months, measurements of anthropometry, lung function, lifestyle parameters and inflammatory markers were assessed. Analyses were performed with linear mixed models for longitudinal analyses. Results After 18 months, the body mass index-standard deviation score decreased by -0.14±0.29 points (p<0.01) in the intervention group and -0.12±0.34 points (p<0.01) in the control group. This change over time did not differ between groups (p>0.05). Asthma features (including asthma control and asthma-related quality of life) and lung function indices (static and dynamic) improved significantly over time in both groups. The FVC% predicted improved over time by 10.1 ± 8.7% in the intervention group (p<0.001), which was significantly greater than the 6.1 ± 8.4% in the control group (p<0.05). Conclusions & clinical relevance Clinically relevant improvements in body weight, lung function and asthma features were found in both the intervention and control group, although some effects were more pronounced in the intervention group (FVC, asthma control, and quality of life). This implies that a weight reduction intervention could be clinically beneficial for children with asthma. Trial Registration ClinicalTrials.gov NCT00998413
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Affiliation(s)
- Maartje Willeboordse
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Kim D. G. van de Kant
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
| | - Frans E. S. Tan
- Department of Methodology and Statistics, CAPHRI, MUMC, Maastricht, the Netherlands
| | - Sandra Mulkens
- Department of Clinical Psychological Science, School for Experimental Psychopathology (EPP), Maastricht University, Faculty of Psychology and Neuroscience, Maastricht, the Netherlands
| | | | - Yvonne Crijns
- Department of Physiotherapy, MUMC, Maastricht, the Netherlands
| | | | | | - Edward Dompeling
- Department of Paediatric Pulmonology, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), Maastricht, the Netherlands
- * E-mail:
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28
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Aragona E, El-Magbri E, Wang J, Scheckelhoff T, Scheckelhoff T, Hyacinthe A, Nair S, Khan A, Nino G, Pillai DK. Impact of Obesity on Clinical Outcomes in Urban Children Hospitalized for Status Asthmaticus. Hosp Pediatr 2016; 6:211-8. [PMID: 27012614 DOI: 10.1542/hpeds.2015-0094] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
BACKGROUND AND OBJECTIVE The prevalence of both childhood asthma and obesity remain at historically high levels and disproportionately affect urban children. Asthma is a common and costly cause for pediatric hospitalization. Our objective was to determine the effect of obesity on outcomes among urban children hospitalized with status asthmaticus. METHODS A retrospective cohort study was performed by using billing system data and chart review to evaluate urban children admitted for asthma. Demographics, asthma severity, reported comorbidities, and outcomes were assessed. Obesity was defined by BMI percentile (lean<85%, overweight 85%-95%, obese≥95%). Outcomes were length of stay, hospitalization charges, ICU stay, repeat admissions, and subsequent emergency department (ED) visits. Bivariate analysis assessed for differences between overweight/obese and lean children. Multivariable regression assessed the relationship between overweight status and primary outcomes while controlling for other variables. Post hoc age-stratified analysis was also performed. RESULTS The study included 333 subjects; 38% were overweight/obese. Overweight/obese children admitted with asthma were more likely than lean children to have subsequent ED visits (odds ratio 1.6, 95% confidence interval 1.0-2.6). When stratified by age, overweight/obese preschool-age children (<5 years) were >2 times as likely to have repeat ED visits than lean preschool-age children (odds ratio 2.3, 95% confidence interval 1.0-5.6). There were no differences in the other outcomes between overweight/obese and lean individuals within the entire cohort or within other age groups.
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Affiliation(s)
- Elena Aragona
- Pediatric Hospital Medicine, Tufts Floating Hospital for Children, Boston, Massachusetts;
| | | | | | | | | | | | - Suja Nair
- Pediatric Pulmonology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Amina Khan
- Pediatric Hospital Medicine, Tufts Floating Hospital for Children, Boston, Massachusetts
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Lu KD, Phipatanakul W, Perzanowski MS, Balcer-Whaley S, Matsui EC. Atopy, but not obesity is associated with asthma severity among children with persistent asthma. J Asthma 2016; 53:1033-44. [PMID: 27144330 DOI: 10.3109/02770903.2016.1174259] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND AND OBJECTIVE Obesity is associated with an increased risk of asthma in children. Atopic sensitization is a major risk factor for asthma including severe asthma in children. It is unclear if obesity is associated with worse asthma control or severity in children and how its effects compare to atopy. We sought to examine relationships of weight status and atopy to asthma control and severity among a population of predominantly low income, minority children and adolescents with persistent asthma. METHODS A cross-sectional analysis of 832 children and adolescents, age range 5-17 years, with persistent asthma was performed. Clinical assessments included asthma questionnaires of symptoms, asthma severity score, health care utilization and medication treatment step, lung function testing, and skin prick testing as well as measures of adiposity. Data were collected between December 2010 and August 2014 from Johns Hopkins Hospital in Baltimore, MD and Children's Hospital of Boston, MA. RESULTS Obesity was not associated with worse asthma control or severity in this group of predominantly low income, minority children and adolescents with persistent asthma. However, a greater degree of atopy was associated with lower lung function, higher asthma severity score, and higher medication treatment step. CONCLUSION Atopy may be a more important risk factor for asthma severity than obesity among low-income minority children and adolescents with persistent asthma living in Northeastern cities in the United States.
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Affiliation(s)
- Kim D Lu
- a Department of Pediatrics , Division of Pediatric Pulmonary, University of California, Irvine School of Medicine , Irvine , CA , USA
| | - Wanda Phipatanakul
- b Department of Pediatrics , Harvard Medical School, Children's Hospital , Boston , MA , USA , Division of Allergy and Immunology , Boston , MA , USA
| | - Matthew S Perzanowski
- c Mailman School of Public Health , Columbia University , New York , NY , USA , Columbia Center for Children's Environmental Health , New York , NY , USA
| | - Susan Balcer-Whaley
- d Department of Pediatrics , Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
| | - Elizabeth C Matsui
- d Department of Pediatrics , Division of Pediatric Allergy and Immunology, Johns Hopkins University School of Medicine , Baltimore , MD , USA
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30
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Wang J, Huang Y, Zhang XL, Huang X, Xu XW, Liang FM. [An analysis of skin prick test reactivity to dust mite in overweight and normal weight children with allergic asthma before and after specific immunotherapy]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2016; 18:329-334. [PMID: 27097578 PMCID: PMC7390070 DOI: 10.7499/j.issn.1008-8830.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 01/06/2016] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To study the skin prick test (SPT) reactivity to house dust mite allergens in overweight and normal weight children with allergic asthma before and after standard subcutaneous specific immunotherapy. METHODS Two hundred and fifteen children with allergic asthma who had positive SPT responses to Dermatophagoides pteronyssinus (DP) and Dermatophagoides farinae (DF) were enrolled. According to the weight index, they were classified into overweight (n=63) and normal weight groups (n=152). Skin indices (SI) to DP and DF were compared between the two groups at 6 months and 1 year after standard subcutaneous specific immunotherapy. RESULTS The overweight group had a significantly larger histamine wheal diameter than the normal weight group after controlling the variation in testing time (P<0.05). After controlling the variation in weights, there were significant differences in the SIs to DP and DF before specific immunotherapy and at 6 months and 1 year after specific immunotherapy. At 6 months and 1 year after specific immunotherapy, the SIs to DP and DF were significantly reduced in both groups (P<0.05), and the overweight group had greater decreases in the SIs to DP and DF than the normal weight group. CONCLUSIONS The overweight children with allergic asthma have stronger responses to histamine than the normal weight patients. Specific immunotherapy can reduce the reactivity to dust mite allergens in children with allergic asthma. Within one year after specific immunotherapy, the overweight children with allergic asthma have a significantly greater decrease in the reactivity to dust mite allergens than the normal weight patients.
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Affiliation(s)
- Jian Wang
- Department of Respiration, Children's Hospital of Chongqing Medical University/Ministry of Education Key Laboratory of Child Development and Disorders/China International Science and Technology Cooperation Base of Child Development and Critical Disorders/Chongqing Key Laboratory of Pediatrics, Chongqing 400014, China.
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31
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Xu R, DeMauro SB, Feng R. The impact of parental history on children's risk of asthma: a study based on the National Health and Nutrition Examination Survey-III. J Asthma Allergy 2015; 8:51-61. [PMID: 26045673 PMCID: PMC4448922 DOI: 10.2147/jaa.s80245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Purpose This study aimed to examine the separate effects of maternal and paternal history on the onset of asthma in children and evaluate the relationship between age of asthma onset in parents and risk of asthma in their children. Methods We used data from the third National Health and Nutrition Examination Survey. We developed new continuous standardized scores for survey data to quantify parental history that incorporated both the occurrence of asthma and the age at onset, and associated these scores with asthma risk in the children. The association analysis was adjusted for sex and obesity status. Results Children with maternal history have elevated asthma risk (hazard ratio of 3.71, 95% CI: 1.19–11.60) than those without, and those whose mothers had earlier age of onset have increased risk of asthma compared to those whose mothers had later age of onset. On the contrary, paternal history had a relatively smaller effect that may be only detectable in larger samples (hazard ratio of 2.17, 95% CI: 0.69–6.79). Conclusion Maternal asthma history was strongly associated with the onset of asthma in the second generation, and children whose mother had an earlier age of onset had an increased risk of 3.71. For an approximately 10-year decrease in mother’s age at onset of asthma, the risk of asthma for the offspring increased by 1.37-fold. Using our new risk scores led to smaller standard errors and thus more precise estimates than using a binary indicator.
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Affiliation(s)
- Rengyi Xu
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
| | - Sara B DeMauro
- Division of Neonatology, Perelman School of Medicine at the University of Pennsylvania and The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Rui Feng
- Department of Biostatistics and Epidemiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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32
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Rastogi D, Fraser S, Oh J, Huber AM, Schulman Y, Bhagtani RH, Khan ZS, Tesfa L, Hall CB, Macian F. Inflammation, metabolic dysregulation, and pulmonary function among obese urban adolescents with asthma. Am J Respir Crit Care Med 2015; 191:149-60. [PMID: 25457349 DOI: 10.1164/rccm.201409-1587oc] [Citation(s) in RCA: 135] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
RATIONALE Insulin resistance and low high-density lipoprotein (HDL) are associated with pulmonary morbidity, including asthma, but the underlying mechanisms are not well elucidated. OBJECTIVES To investigate whether systemic inflammation underlies the association of metabolic abnormalities with pulmonary function among urban adolescents. METHODS Th-cell responses and monocyte subsets, and their association with serum homeostatic model assessment of insulin resistance (HOMA-IR) and HDL, and pulmonary function were quantified in 168 adolescents, including 42 obese subjects with asthma, 42 normal-weight subjects with asthma, 40 obese subjects without asthma, and 44 healthy control subjects. Th-cell responses (Th1 [CD4(+)IFNγ(+)] and Th2 [CD4(+)IL4(+)] cells) to stimulation with phytohemagglutinin, leptin, and dust mite, and classical (CD14(+)CD16(-)), resident (CD14(+)CD16(+)), and patrolling (CD14dimCD16(+)) monocytes, and their C-C chemokine receptor type-2 (CCR2) expression were quantified by flow cytometry. MEASUREMENTS AND MAIN RESULTS Th1/Th2 ratio to all three stimuli was higher in obese subjects with asthma than normal-weight subjects with asthma and directly correlated with HOMA-IR. Classical monocytes inversely associated with Th1/Th2 ratio to phytohemagglutinin (r = -0.43; P = 0.01) and directly with Asthma Control Test score (β = 1.09; P = 0.04), while patrolling monocytes correlated with Composite Asthma Severity Index score (β = 1.11; P = 0.04) only among obese subjects with asthma. HDL was inversely associated with patrolling monocytes and directly associated with CCR2 expression on resident monocytes. CCR2 expression on patrolling monocytes predicted residual volume (RV), RV/TLC ratio, and FRC, after adjusting for HDL, but not after adjusting for body mass index. Association of Th1/Th2 ratio with RV, FRC, and inspiratory capacity was attenuated after adjusting for HOMA-IR. CONCLUSIONS Th1 polarization and monocyte activation among obese subjects with asthma correlates with metabolic abnormalities. Association of monocyte activation with pulmonary function is mediated by body mass index, whereas that of Th1 polarization is mediated by insulin resistance.
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Raj D, Kabra SK, Lodha R. Childhood obesity and risk of allergy or asthma. Immunol Allergy Clin North Am 2014; 34:753-65. [PMID: 25282288 DOI: 10.1016/j.iac.2014.07.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The simultaneous increment in the prevalence of obesity and allergic diseases suggests a possible link between them. This review focuses on the consequences of obesity on allergic diseases, especially asthma in children and adolescents, and evaluates the available evidence on the possible mechanisms. Obesity is related more strongly to nonatopic than atopic asthma, suggesting non-eosinophilic inflammation and Th1 polarization. Among other allergic diseases, the association is more consistent with eczema compared to allergic rhinitis/rhinoconjunctivitis. The mechanisms of asthma in obese individuals could involve mechanical effects of obesity on lung function, adipokines-mediated inflammation, shared factors (diet, genetics, sedentary lifestyle) and comorbidities.
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Affiliation(s)
- Dinesh Raj
- Department of Pediatrics, Holy Family Hospital, Okhla, New Delhi 110025, India
| | - Sushil K Kabra
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India
| | - Rakesh Lodha
- Department of Pediatrics, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
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Dahm PH, Richards JB, Karmouty-Quintana H, Cromar KR, Sur S, Price RE, Malik F, Spencer CY, Barreno RX, Hashmi SS, Blackburn MR, Haque IU, Johnston RA. Effect of antigen sensitization and challenge on oscillatory mechanics of the lung and pulmonary inflammation in obese carboxypeptidase E-deficient mice. Am J Physiol Regul Integr Comp Physiol 2014; 307:R621-33. [PMID: 25009214 DOI: 10.1152/ajpregu.00205.2014] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Atopic, obese asthmatics exhibit airway obstruction with variable degrees of eosinophilic airway inflammation. We previously reported that mice obese as a result of a genetic deficiency in either leptin (ob/ob mice) or the long isoform of the leptin receptor (db/db mice) exhibit enhanced airway obstruction in the presence of decreased numbers of bronchoalveolar lavage fluid (BALF) eosinophils compared with lean, wild-type mice following antigen (ovalbumin; OVA) sensitization and challenge. To determine whether the genetic modality of obesity induction influences the development of OVA-induced airway obstruction and OVA-induced pulmonary inflammation, we examined indices of these sequelae in mice obese as a result of a genetic deficiency in carboxypeptidase E, an enzyme that processes prohormones and proneuropeptides involved in satiety and energy expenditure (Cpe(fat) mice). Accordingly, Cpe(fat) and lean, wild-type (C57BL/6) mice were sensitized to OVA and then challenged with either aerosolized PBS or OVA. Compared with genotype-matched, OVA-sensitized and PBS-challenged mice, OVA sensitization and challenge elicited airway obstruction and increased BALF eosinophils, macrophages, neutrophils, IL-4, IL-13, IL-18, and chemerin. However, OVA challenge enhanced airway obstruction and pulmonary inflammation in Cpe(fat) compared with wild-type mice. These results demonstrate that OVA sensitization and challenge enhance airway obstruction in obese mice regardless of the genetic basis of obesity, whereas the degree of OVA-induced pulmonary inflammation is dependent on the genetic modality of obesity induction. These results have important implications for animal models of asthma, as modeling the pulmonary phenotypes for subpopulations of atopic, obese asthmatics critically depends on selecting the appropriate mouse model.
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Affiliation(s)
- Paul H Dahm
- Division of Critical Care Medicine, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
| | - Jeremy B Richards
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Harry Karmouty-Quintana
- Department of Biochemistry and Molecular Biology, The University of Texas Medical School at Houston, Houston, Texas
| | - Kevin R Cromar
- Department of Environmental Medicine, New York University School of Medicine, Tuxedo, New York
| | - Sanjiv Sur
- Division of Allergy and Immunology, Department of Internal Medicine, The University of Texas Medical Branch at Galveston School of Medicine, Galveston, Texas
| | - Roger E Price
- Comparative Pathology Laboratory, Center for Comparative Medicine, Baylor College of Medicine, Houston, Texas
| | - Farhan Malik
- Division of Critical Care Medicine, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
| | - Chantal Y Spencer
- Pediatric Pulmonary Section, Department of Pediatrics, Baylor College of Medicine, Houston, Texas; and
| | - Ramon X Barreno
- Division of Critical Care Medicine, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
| | - Syed S Hashmi
- Pediatric Research Center, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
| | - Michael R Blackburn
- Department of Biochemistry and Molecular Biology, The University of Texas Medical School at Houston, Houston, Texas
| | - Ikram U Haque
- Division of Critical Care Medicine, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
| | - Richard A Johnston
- Division of Critical Care Medicine, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas; Pediatric Research Center, Department of Pediatrics, The University of Texas Medical School at Houston, Houston, Texas
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Chen CF, Lv Y, Zhang HP, Wang G. Does zafirlukast reduce future risk of asthma exacerbations in adults? Systematic review and meta-analysis. Multidiscip Respir Med 2014; 9:30. [PMID: 24936302 PMCID: PMC4059702 DOI: 10.1186/2049-6958-9-30] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2014] [Accepted: 05/06/2014] [Indexed: 02/05/2023] Open
Abstract
Background and objective The purpose of asthma management is to achieve a total asthma control that involves current control and future risk. It has proven efficacy in reducing asthma exacerbations, but the effect size of zafirlukast for asthma exacerbations of various severity is not systematically explored. Methods Randomized controlled trials were searched in PubMed Central, Web of Science, and Embase, where zafirlukast prevented asthma exacerbations in adults. The primary outcome was asthma exacerbations, the secondary outcomes were asthma exacerbations requiring systemic corticosteroids and emergency visits, respectively. Odds ratio (OR) with 95% confidence intervals (CI) were pooled. Results Twelve trials were identified. As first-line therapy, compared to those having placebo, the patients with chronic asthma receiving zafirlukast experienced statistically lower asthma exacerbations (OR = 0.68, 95% CI = [0.45, 1.00]), but it was not found that zafirlukast was superior to placebo in asthma exacerbations requiring systemic corticosteroids (OR = 0.76, 95% CI = [0.45, 1.29]). Furthermore, zafirlukast was inferior to ICs in asthma exacerbations (OR = 2.11, 95% CI = [1.35, 3.30]) and requiring systemic corticosteroids (OR = 3.71, 95% CI = [1.82, 7.59]). As add-on therapy, zafirlukast was not superior to placebo in asthma exacerbations (OR =0.99, 95% CI = [0.54, 1.81] and requiring emergency visits (OR = 0.72, 95% CI = [0.18, 2.99]). Intriguingly, there was not a significant difference in asthma exacerbations between zafirlukast and ICs (OR = 1.12, 95% CI = [0.53, 2.34]). Conclusions Our study suggests that zafirlukast, as the first-line therapy, significantly reduces mild to moderate but not severe asthma exacerbations. In the add-on regimen, zafirlukast could not reduce asthma exacerbations, which would perhaps result from small sample size and needs to be further studied.
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Affiliation(s)
- Chao Feng Chen
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Yan Lv
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Hong Ping Zhang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
| | - Gang Wang
- Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China
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Zwintscher NP, Horton JD, Steele SR. Obesity has minimal impact on clinical outcomes in children with inflammatory bowel disease. J Pediatr Surg 2014; 49:265-8; discussion 268. [PMID: 24528963 DOI: 10.1016/j.jpedsurg.2013.11.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2013] [Accepted: 11/10/2013] [Indexed: 01/04/2023]
Abstract
PURPOSE Childhood obesity is an increasing problem in affluent societies throughout the world. We sought to identify the impact of obesity on the outcome of inflammatory bowel disease (IBD) and determine differences (if any) between ulcerative colitis (UC) and Crohn's disease (CD). METHODS The 2009 Kids' Inpatient Database was explored for all children (≤ 20 years) admitted with IBD. ICD-9 codes were used to identify obesity and complications, including hemorrhage, perforation, and complex fistulas. Logistic regression analysis accounting for demographics, underlying disease, surgical procedures, and obesity was performed to identify factors associated with complication development. Data are expressed as odds ratios (OR) and a 95% confidence interval (CI). A P value of 0.05 was regarded as significant. RESULTS From 12,465 admissions, 164 children were obese (1.3%), with no difference between CD and UC (1.3% vs. 1.4%; P=0.60). Girls had a two-fold increase in obesity (OR: 2.06, CI: 1.48-2.86; P<0.01). Obesity had no effect on elective/emergent admission rate (OR: 0.85, CI: 0.54-1.35; P=0.49), perforation (OR: 0.76, CI: 0.13-4.46; P=0.76), hemorrhage (OR: 0.64,CI: 0.34-1.21; P=0.17), complex fistula (OR: 1.19, CI: 0.45-3.17; P=0.72), or requirement for surgery (OR: 0.80, CI: 0.48-1.31; P=0.37). While the overall clinical morbidity rate was 10.7%, obesity was not associated with the development of overall complications (OR 1.20, CI: 0.75-1.93; P=0.45) or length of stay (6.36 vs. 6.10 days; P=0.61). Obesity increased the rate of central venous catheter (CVC) infections (OR: 10.98, CI: 2.50-48.20; P<0.01). CONCLUSIONS Obesity was more prevalent in girls with IBD. While obesity did not alter disease severity, rate of surgical intervention, or hospital length of stay, it was associated with higher CVC infections.
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Affiliation(s)
| | - John D Horton
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA
| | - Scott R Steele
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA, USA
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Black MH, Zhou H, Takayanagi M, Jacobsen SJ, Koebnick C. Increased asthma risk and asthma-related health care complications associated with childhood obesity. Am J Epidemiol 2013; 178:1120-8. [PMID: 23924576 PMCID: PMC3857927 DOI: 10.1093/aje/kwt093] [Citation(s) in RCA: 95] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Accepted: 04/23/2013] [Indexed: 01/05/2023] Open
Abstract
Asthma is the most common chronic condition of childhood, yet the relationship between obesity and asthma risk and the impact of obesity on clinical asthma outcomes are not well understood. For this population-based, longitudinal study, demographic and clinical data were extracted from administrative and electronic health records of 623,358 patients aged 6-19 years who were enrolled in the Kaiser Permanente Southern California health plan in 2007-2011. Crude asthma incidence ranged from 16.9 per 1,000 person-years among normal-weight youth to 22.3 per 1,000 person-years among extremely obese youth. The adjusted risks of asthma for overweight, moderately obese, and extremely obese youth relative to those of normal weight youth were 1.16 (95% confidence interval: 1.13, 1.20), 1.23 (95% confidence interval: 1.19, 1.28), and 1.37 (95% confidence interval: 1.32, 1.42), respectively (Ptrend < 0.0001). The relationship between obesity and asthma risk was strongest in Asian/Pacific Islanders and in the youngest girls (aged 6-10 years), compared with other groups. Among youth who developed asthma, those who were moderately or extremely obese had more frequent asthma exacerbations requiring emergency department services and/or treatment with oral corticosteroids. In conclusion, obese youth are not only more likely to develop asthma, but they may be more likely to have severe asthma, resulting in a greater need for health care utilization and aggressive asthma treatment.
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Affiliation(s)
- Mary Helen Black
- Correspondence to Dr. Mary Helen Black, Department of Research and Evaluation, Kaiser Permanente Southern California, 100 Los Robles, Second Floor, Pasadena, CA 91101 (e-mail: )
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Lang JE, Holbrook JT, Wise RA, Dixon AE, Teague WG, Wei CY, Irvin CG, Shade D, Lima JJ. Obesity in children with poorly controlled asthma: Sex differences. Pediatr Pulmonol 2013; 48:847-56. [PMID: 23143849 PMCID: PMC3578966 DOI: 10.1002/ppul.22707] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2012] [Accepted: 08/22/2012] [Indexed: 11/05/2022]
Abstract
BACKGROUND Obesity increases asthma risk, and may alter asthma severity. In adults, sex appears to modify the effect of obesity on asthma. Among children, the effect of sex on the relationship between obesity and asthma severity remains less clear, particularly when considering race. OBJECTIVE To determine how obesity affects disease characteristics in a diverse cohort of children with poorly controlled asthma, and if obesity effects are altered by sex. DESIGN We analyzed 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month trial assessing lansoprazole for asthma control. In this secondary analysis, we determined associations between obesity and symptom severity, spirometry, exacerbation risk, airway biomarkers, bronchial reactivity, and airflow perception. We used both a multivariate linear regression and longitudinal mixed-effect model to determine if obesity interacted with sex to affect asthma severity. RESULTS Regardless of sex, BMI >95th percentile did not affect asthma control, exacerbation risk or airway biomarkers. Sex changed the effect of obesity on lung function (sex × obesity FEV1%, interaction P-value < 0.01, sex × obesity FEV1/FVC, interaction P-value = 0.03). Obese males had significantly worse airflow obstruction compared to non-obese males, while in females there was no obesity effect on airflow obstruction. In females, obesity was associated with significantly greater FEV1 and FVC, and a trend toward reduced airway reactivity. CONCLUSIONS Obesity did not affect asthma control, airway markers or disease stability; however obesity did affect lung function in a sex-dependent manner. In males, obesity associated with reduced FEV1/FVC, and in females, obesity associated with substantially improved lung function.
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Affiliation(s)
- Jason E Lang
- Division of Pulmonology, Allergy & Immunology, Nemours Children's Clinic, Jacksonville, Florida, USA.
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Current world literature. Curr Opin Allergy Clin Immunol 2013; 13:217-21. [PMID: 23434741 DOI: 10.1097/aci.0b013e32835f8a7a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Beydon N, Delclaux C. BMI as a comorbidity factor in childhood asthma. Expert Rev Respir Med 2013; 6:569-71. [PMID: 23234442 DOI: 10.1586/ers.12.66] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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Willeboordse M, van de Kant KDG, de Laat MN, van Schayck OCP, Mulkens S, Dompeling E. Multifactorial intervention for children with asthma and overweight (Mikado): study design of a randomised controlled trial. BMC Public Health 2013; 13:494. [PMID: 23692648 PMCID: PMC3682864 DOI: 10.1186/1471-2458-13-494] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Accepted: 05/17/2013] [Indexed: 12/22/2022] Open
Abstract
Background In children, the prevalence’s of both obesity and asthma are disconcertingly high. Asthmatic children with obesity are characterised by less asthma control and a high need for asthma medication. As the obese asthmatic child is becoming more common in the clinical setting and the disease burden of the asthma-obesity phenotype is high, there is an increasing need for effective treatment in these children. In adults, weight reduction resulted in improved lung function, better asthma control and less need for asthma medication. In children this is hardly studied. The Mikado study aims to evaluate the effectiveness of a long term multifactorial weight reduction intervention, on asthma characteristics in children with asthma and a high body weight. Methods/design The Mikado study is a two-armed, randomised controlled trial. In total, 104 participants will be recruited via online questionnaires, pulmonary paediatricians, the youth department of the Municipal Health Services and cohorts of existing studies. All participants will be aged 6–16 years, will have current asthma, a Body Mass Index in the overweight or obesity range, and no serious comorbidities (such as diabetes, heart diseases). Participants in the intervention arm will receive a multifactorial intervention of 18 months consisting of sessions concerning sports, parental involvement, individual counselling and lifestyle advices including dietary advices and cognitive behavioural therapy. The control group will receive usual care. The primary outcome variables will include Forced Expiratory Volume in one second and Body Mass Index - Standard Deviation Score. Secondary outcomes will include other lung function parameters (including dynamic and static lung function parameters), asthma control, asthma-specific quality of life, use of asthma medication and markers of systemic inflammation and airway inflammation. Discussion In this randomised controlled trial we will study the potential of a multifactorial weight reduction intervention to improve asthma-related outcome measures in asthmatic children with overweight. Moreover, it will provide information about the underlying mechanisms in the relationship between asthma and a high body weight in children. These findings can contribute to optimal management programs and better clinical guidelines for children with asthma and overweight. Trial registration Clinicaltrial.gov NCT00998413
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Affiliation(s)
- Maartje Willeboordse
- Department of Paediatric Respiratory Medicine, School for Public Health and Primary Care (CAPHRI), Maastricht University Medical Centre (MUMC), P, Debyelaan 25, P,O, Box 5800, Maastricht, AZ, 6202, The Netherlands.
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Dorevitch S, Conroy L, Karadkhele A, Rosul L, Stacewicz-Sapuntzakis M, Fantuzzi G. Associations between obesity and asthma in a low-income, urban, minority population. Ann Allergy Asthma Immunol 2013; 110:340-6. [PMID: 23622004 DOI: 10.1016/j.anai.2013.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 01/03/2013] [Accepted: 02/04/2013] [Indexed: 10/27/2022]
Abstract
BACKGROUND Community-based studies of obesity, asthma, biomarkers of oxidative stress, and adipokines among low-income, urban, minority populations are lacking. Oxidative stress, perhaps modulated by adipokines, may increase airway inflammation in obese individuals. OBJECTIVES To characterize associations between obesity and asthma in a low-income, urban, minority community and evaluate adipokines, biomarkers of inflammation, and oxidant-antioxidant balance in association with asthma and obesity. METHODS A door-to-door evaluation of asthma and obesity prevalence was performed in a low-income housing development. Nonsmoking adults and children underwent additional evaluation, including allergy skin testing, and measures of serum adipokines, and indicators of oxidative stress in blood and exhaled breath. RESULTS The prevalences of current asthma and a body mass index in the 85th percentile or higher were 15.8% and 35.3%, respectively, among 350 nonsmokers older than 4 years. Asthma and obesity were not associated with one another (odds ratio, 1.0; 95% confidence interval, 0.55-1.84). Among 116 nonsmoking participants who underwent biomarker evaluation, obesity was not associated with exhaled nitric oxide. In multivariate logistic models that adjusted for age category, sex, and a body mass index in 85th percentile or higher, leptin concentrations in the highest quartile were associated with asthma (odds ratio, 8.34; 95% confidence interval, 1.29-50.2) but not with atopy. Adiponectin was associated with total antioxidant capacity in exhaled breath. CONCLUSION Asthma and obesity, although both common in a low-income, minority community, were not associated with one another. Nevertheless, adipokines were associated with asthma status and with markers of oxidative stress in the lungs, providing some support for an adipokine-inflammatory mechanistic link between the two conditions.
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Affiliation(s)
- Samuel Dorevitch
- Division of Environmental and Occupational Health Sciences, University of Illinois at Chicago School of Public Health, Chicago, IL 60612, USA.
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