[Association between body mass index and lung function in children with asthma after corticosteroids inhalation]
Ze-Hui Ye1, Ying Huang, Ying Wang
1Department of Respiratory Medicine, Children's Hospital of Chongqing Medical University, Chongqing 400014, China. huangying62@126.com.
Insights
Obesity negatively impacts lung function in asthmatic children, increasing airway sensitivity and reducing treatment effectiveness. Inhaled corticosteroids (ICS) improve large airway function in normal-weight children but not in obese or overweight children.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Obesity Research
Context:
- Asthma is a chronic respiratory condition affecting children worldwide.
- Childhood obesity rates are rising, potentially impacting asthma management.
- Inhaled corticosteroids (ICS) are a cornerstone of asthma therapy.
Purpose:
- To investigate the relationship between body mass index (BMI) and lung function in asthmatic children receiving ICS.
- To assess the effects of obesity on airway hyperresponsiveness and bronchodilator response in pediatric asthma.
- To evaluate the efficacy of ICS in improving lung function across different BMI categories in asthmatic children.
Summary:
- A study of 157 asthmatic children categorized by BMI (obese, overweight, normal-weight) found obesity increased methacholine sensitivity and reduced salbutamol response.
- After one year of ICS treatment, normal-weight children showed improved large airway function (FVC%, FEV1%), while obese and overweight children had limited improvement.
- Small airway function (MEF25%, MEF50%) did not significantly improve with ICS in any BMI group, suggesting obesity may hinder ICS effectiveness.
Impact:
- Findings highlight that obesity complicates asthma control in children, potentially diminishing the benefits of standard ICS therapy.
- This research underscores the need for weight management strategies in obese asthmatic children to optimize respiratory outcomes.
- The study suggests that current ICS regimens may be less effective for improving lung function in overweight and obese pediatric asthma patients.
Objective:
To study the association between body mass index (BMI) and lung function of asthmatic children after inhaling corticosteroids (ICS).
Methods:
One hundred and fifty-seven children with asthma were classified into obese (46 cases), over-weight (50 cases) and normal-weight groups (61 cases) based on BMI. All of the children received ICS for one year. Pulmonary functions were evaluated before and after treatment. Large airway function includes forced expiratory volume in one second (FEV1%) and forced vital capacity (FVC%). Small airway function includes maximal expiratory flow 25 (MEF25%) and maximal expiratory flow 50 (MEF50%).
Results:
The bronchial provocation test before treatment showed that the decline rate of pulmonary function (FVC%, FEV1%, MEF25% and MEF50%) in the obese group was higher than the normal-weight group after methacholine inhalation. After salbutamol inhalation, the improvement rate of the large airway (FVC%) and small airway (MEF25% and MEF50%) functions in the obese group was lower than the normal-weight group, and the improvement rate of small airway (MEF25% and MEF50%) function in the over-weight group was lower than in the normal-weight group. After treatment with ICS for one year, large airway function (FVC% and FEV1%) in the normal-weight group was higher than pre-treatment, however only FVC% in the normal-weight and obese groups was higher than pre-treatment. There was no significant difference in small airway function before and after treatment in all three groups.
Conclusions:
Obesity can increase the sensitivity to methacholine and restrain the sensitivity to tosalbutamol in children with asthma. ICS can improve the large airway function in asthmatic children with normal body weight, but has no effect on small airway function. Obesity can restrain the effect of ICS on asthmatic children.
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