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Poor asthma control in obese children may be overestimated because of enhanced perception of dyspnea

Pravin K Sah, W Gerald Teague, Karen A Demuth

    The Journal of Allergy and Clinical Immunology. in Practice
    |May 7, 2013
    PubMed

    Insights

    Asthmatic children with obesity experience worse quality of life and more healthcare use, not poorer asthma control. Their symptoms like dyspnea may be heightened due to chest wall changes.

    Area of Science:

    • Pediatric Pulmonology
    • Asthma Research
    • Obesity and Health

    Background:

    • Adult asthma studies suggest a non-T helper 2 (TH2) phenotype in obesity.
    • It remains unclear if a similar asthma phenotype exists in obese children.

    Purpose of the Study:

    • To investigate if obese children with asthma exhibit poorer asthma control, reduced quality of life, increased healthcare utilization, and diminished pulmonary function.
    • To explore the association between obesity, asthma control, and T helper 1 (TH1) versus TH2 immune responses.

    Main Methods:

    • Post hoc analysis of cross-sectional data from 269 children (6-17 years) in the Severe Asthma Research Program.
    • Data collection included questionnaires, spirometry, plethysmography, exhaled nitric oxide, and TH1/TH2 cytokine determination.
    • Asthma control was assessed using national guidelines based on lung function and symptom frequency.

    Main Results:

    • Obese children (25%) did not show poorer asthma control but reported more nonspecific symptoms (dyspnea, nocturnal awakenings).
    • Obese children had decreased asthma-related quality of life and increased healthcare utilization, independent of airflow limitation.
    • A specific TH1 or TH2 polarization pattern was not observed; however, obese children exhibited decreased functional residual capacity.

    Conclusions:

    • The perception of poor asthma control in obese children may be overestimated due to heightened awareness of nonspecific symptoms from altered chest wall mechanics.
    • A comprehensive evaluation of obese children with respiratory symptoms requires careful consideration of both physiological measures and symptom reporting.
    Abstract

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