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Obesity and Airway Dysanapsis in Children with and without Asthma
Erick Forno1, Daniel J Weiner1, James Mullen1
11 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
Insights
Childhood obesity is linked to airway dysanapsis, a growth imbalance in the lungs and airways. This condition increases asthma morbidity in obese children, potentially explaining their reduced response to inhaled corticosteroids.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Childhood Obesity Research
Background:
- Obese children with asthma exhibit higher morbidity and diminished response to inhaled corticosteroids for unknown reasons.
- Investigating the underlying mechanisms is crucial for improving asthma management in this population.
Purpose of the Study:
- To determine if childhood obesity is associated with airway dysanapsis (incongruent lung and airway growth).
- To assess if airway dysanapsis correlates with increased asthma morbidity in children.
Main Methods:
- Examined six pediatric cohorts (with and without asthma) to analyze obesity-dysanapsis relationships.
- Utilized cross-sectional and longitudinal analyses, calculating odds ratios (ORs) and hazard ratios (HRs).
- Assessed clinical outcomes in children with asthma using data from the Childhood Asthma Management Program.
Main Results:
- Overweight/obesity significantly associated with dysanapsis in both cross-sectional (OR 1.95) and longitudinal (OR 4.31) analyses.
- Dysanapsis linked to altered lung volumes, reduced airflow, ventilation inhomogeneity, and anisotropic growth.
- In obese children with asthma, dysanapsis correlated with severe exacerbations (HR 1.95) and systemic steroid use (HR 3.22).
Conclusions:
- Childhood obesity is demonstrably associated with airway dysanapsis.
- Airway dysanapsis contributes to increased asthma morbidity in obese children.
- Dysanapsis may partially explain the reduced efficacy of inhaled corticosteroids in this demographic.
Rationale:
For unclear reasons, obese children with asthma have higher morbidity and reduced response to inhaled corticosteroids.
Objectives:
To assess whether childhood obesity is associated with airway dysanapsis (an incongruence between the growth of the lungs and the airways) and whether dysanapsis is associated with asthma morbidity.
Methods:
We examined the relationship between obesity and dysanapsis in six cohorts of children with and without asthma, as well as the relationship between dysanapsis and clinical outcomes in children with asthma. Adjusted odds ratios (ORs) were calculated for each cohort and in a combined analysis of all cohorts; longitudinal analyses were also performed for cohorts with available data. Hazard ratios (HRs) for clinical outcomes were calculated for children with asthma in the Childhood Asthma Management Program.
Measurements And Main Results:
Being overweight or obese was associated with dysanapsis in both the cross-sectional (OR, 1.95; 95% confidence interval [CI], 1.62-2.35 [for overweight/obese compared with normal weight children]) and the longitudinal (OR, 4.31; 95% CI, 2.99-6.22 [for children who were overweight/obese at all visits compared with normal weight children]) analyses. Dysanapsis was associated with greater lung volumes (FVC, vital capacity, and total lung capacity) and lesser flows (FEV1 and forced expiratory flow, midexpiratory phase), and with indicators of ventilation inhomogeneity and anisotropic lung and airway growth. Among overweight/obese children with asthma, dysanapsis was associated with severe disease exacerbations (HR, 1.95; 95% CI, 1.38-2.75) and use of systemic steroids (HR, 3.22; 95% CI, 2.02-5.14).
Conclusions:
Obesity is associated with airway dysanapsis in children. Dysanapsis is associated with increased morbidity among obese children with asthma and may partly explain their reduced response to inhaled corticosteroids.
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