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Decreased response to inhaled steroids in overweight and obese asthmatic children
Erick Forno1, Rachel Lescher, Robert Strunk
1Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Boston, Mass, USA. eforno@med.miami.edu
Insights
Overweight children with asthma respond less effectively to inhaled budesonide treatment. This decreased response impacts lung function and reduces the effectiveness in preventing emergency visits compared to normal-weight children.
Area of Science:
- Pediatric Pulmonology
- Obesity Medicine
- Clinical Pharmacology
Background:
- The relationship between childhood obesity and asthma is not fully understood.
- Obesity may influence how children with asthma respond to treatments.
Purpose of the Study:
- To investigate the impact of obesity on the effectiveness of inhaled corticosteroids in treating pediatric asthma.
- To determine if body mass index (BMI) affects treatment response to budesonide in children with asthma.
Main Methods:
- A post hoc analysis of the Childhood Asthma Management Program trial data was conducted.
- Researchers evaluated the interaction between BMI and budesonide treatment on lung function.
- Participants were categorized into overweight/obese and nonoverweight groups for longitudinal analysis over 4 years.
Main Results:
- A significant interaction between BMI and budesonide was observed for FEV1/FVC ratio and bronchodilator response.
- Nonoverweight children showed consistent lung function improvement with budesonide throughout the trial.
- Overweight/obese children demonstrated a diminished and less sustained response to budesonide, particularly in later stages, and did not experience reduced emergency visits.
Conclusions:
- Overweight/obese children exhibit a reduced response to inhaled budesonide compared to normal-weight children.
- This decreased response affects lung function measures and the prevention of asthma-related emergency department visits or hospitalizations.
Background:
The mechanisms and consequences of the observed association between obesity and childhood asthma are unclear.
Objectives:
We sought to determine the effect of obesity on treatment responses to inhaled corticosteroids in asthmatic children.
Methods:
We performed a post hoc analysis to evaluate the interaction between body mass index (BMI) and treatment with inhaled budesonide on lung function in the Childhood Asthma Management Program trial. Participants were then stratified into overweight/obese and nonoverweight groups, and their response to inhaled budesonide was analyzed longitudinally over the 4 years of the trial.
Results:
There was a significant interaction between BMI and budesonide for prebronchodilator FEV(1)/forced vital capacity (FVC) ratio (P = .0007) and bronchodilator response (BDR; P = .049) and a nonsignificant trend for an interaction between BMI and budesonide on prebronchodilator FEV(1) (P = .15). Nonoverweight children showed significant improvement with inhaled budesonide in lung function (FEV(1), FEV(1)/FVC ratio, and BDR) during the early (years 1-2) and late (years 3-4) stages of the trial. Overweight/obese children had improved FEV(1) and BDR during the early but not the late stage of the trial and showed no improvement in FEV(1)/FVC ratio. When comparing time points at which both groups showed a significant response, the degree of improvement among nonoverweight children was significantly greater than in overweight/obese children at most visits. Nonoverweight children had a 44% reduction in the risk of emergency department visits or hospitalizations throughout the trial (P = .001); there was no reduction in risk among overweight/obese children (P = .97).
Conclusions:
Compared with children of normal weight, overweight/obese children in the Childhood Asthma Management Program showed a decreased response to inhaled budesonide on measures of lung function and emergency department visits/hospitalizations for asthma.
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