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Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma
Meghan E McGarry1, Elizabeth Castellanos2, Neeta Thakur3
1Department of Pediatrics, University of California, San Francisco, CA.
Insights
Obese children with asthma are more likely to be unresponsive to bronchodilators, leading to poorer asthma control. This study highlights the link between obesity and reduced bronchodilator response in pediatric asthma patients.
Area of Science:
- Pediatric Pulmonology
- Obesity Medicine
- Epidemiology
Background:
- Obesity is linked to increased asthma severity and reduced treatment effectiveness.
- The relationship between obesity and bronchodilator responsiveness in pediatric asthma requires further investigation.
Purpose of the Study:
- To investigate the association between obesity and bronchodilator responsiveness in children and adolescents with asthma.
- To determine if obese, bronchodilator-unresponsive asthmatic subjects experience worse asthma control.
Main Methods:
- Analysis of data from 2,963 black and Latino subjects in the SAGE II and GALA II studies (2008-2013).
- Utilized multivariable logistic regression to examine the association between obesity (BMI ≥ 95th percentile) and bronchodilator unresponsiveness.
- Compared asthma symptoms, controller medication use, and exacerbations between obese and non-obese groups.
Main Results:
- Obese children and adolescents with asthma had a 24% higher odds of being bronchodilator unresponsive.
- Bronchodilator-unresponsive obese subjects reported more wheezing, nighttime awakenings, and increased use of specific asthma medications.
- These associations were not observed in the bronchodilator-responsive group.
Conclusions:
- Obesity is significantly associated with bronchodilator unresponsiveness in black and Latino children and adolescents with asthma.
- The findings underscore the importance of addressing obesity to improve asthma control in these populations.
Background:
Obesity is associated with poor asthma control, increased asthma morbidity, and decreased response to inhaled corticosteroids. We hypothesized that obesity would be associated with decreased bronchodilator responsiveness in children and adolescents with asthma. In addition, we hypothesized that subjects who were obese and unresponsive to bronchodilator would have worse asthma control and would require more asthma controller medications.
Methods:
In the Study of African Americans, Asthma, Genes, and Environments (SAGE II) and the Genes-environments and Admixture in Latino Americans (GALA II) study, two identical, parallel, case-control studies of asthma, we examined the association between obesity and bronchodilator response in 2,963 black and Latino subjects enrolled from 2008 to 2013 using multivariable logistic regression. Using bronchodilator responsiveness, we compared asthma symptoms, controller medication usage, and asthma exacerbations between nonobese (< 95th% BMI) and obese (≥ 95th% BMI) subjects.
Results:
The odds of being bronchodilator unresponsive were 24% (OR, 1.24; 95% CI, 1.03-1.49) higher among obese children and adolescents compared with their not obese counterparts after adjustment for age, race/ethnicity, sex, recruitment site, baseline lung function (FEV1/FVC), and controller medication. Bronchodilator-unresponsive obese subjects were more likely to report wheezing (OR, 1.38; 95% CI, 1.13-1.70), being awakened at night (OR, 1.34; 95% CI, 1.09-1.65), using leukotriene receptor inhibitors (OR, 1.33; 95% CI, 1.05-1.70), and using inhaled corticosteroid with long-acting β2-agonist (OR, 1.37; 95% CI, 1.05-1.78) than were their nonobese counterpart. These associations were not seen in the bronchodilator-responsive group.
Conclusions:
Obesity is associated with bronchodilator unresponsiveness among black and Latino children and adolescents with asthma. The findings on obesity and bronchodilator unresponsiveness represent a unique opportunity to identify factors affecting asthma control in blacks and Latinos.
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