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Obese- and allergic-related asthma phenotypes among children across the United States
Mindy K Ross1, Tahmineh Romero2, Myung S Sim2
1a University of California, Pediatrics, Pediatric Pulmonology , Los Angeles , California , United States.
Insights
Pediatric asthma varies by phenotype. Allergic-not-obese asthma is common, but obese-and-allergic asthma is linked to more severe cases in children.
Area of Science:
- Pediatric Pulmonology
- Allergy and Immunology
- Public Health
Background:
- Pediatric asthma is a heterogeneous condition with diverse underlying inflammation and pathophysiology.
- Understanding the national prevalence of specific asthma phenotypes, particularly those related to obesity and allergies, is crucial for effective management.
Purpose of the Study:
- To assess the national prevalence of four pediatric asthma phenotypes: not-allergic-not-obese, allergic-not-obese, obese-not-allergic, and allergic-and-obese.
- To identify risk factors and caregiver-reported severity associated with each asthma phenotype.
Main Methods:
- Analysis of data from the 2007-2008 National Survey of Children's Health (NSCH) involving 4,427 children aged 10-17 with asthma.
- Utilized logistic and ordinal regression models to determine phenotype associations and severity.
Main Results:
- Race was significantly associated with asthma phenotype; white children were more likely to have allergic-not-obese asthma, while Black and Hispanic children were more likely to have obese-nonallergic asthma.
- Attention-deficit/hyperactivity disorder (ADHD) was more prevalent in allergic-not-obese children (OR 1.50).
- The obese-and-allergic asthma phenotype showed the highest risk for severe asthma (OR 3.34).
Conclusions:
- Allergic-not-obese asthma represented half of the phenotypes, while obesity-related asthma accounted for one-fifth in this US representative cohort.
- Children with both obese and allergic asthma are at the highest risk for severe disease.
- Future childhood asthma management should consider tailored treatment plans based on distinct asthma phenotypes.
Objectives:
Pediatric asthma is heterogeneous with phenotypes that reflect differing underlying inflammation and pathophysiology. Little is known about the national prevalence of certain obesity- and allergy-related asthma phenotypes or associated characteristics. We therefore assessed the national prevalence, risk factors, and caregiver-reported severity of four asthma phenotypes: not-allergic-not-obese, allergic-not-obese, obese-not-allergic, and allergic-and-obese.
Methods:
We analyzed data from the 2007-2008 National Survey of Children's Health (NSCH) of 10-17 year-olds with caregiver-reported asthma. We described sociodemographic and health risk factors of each phenotype and then applied logistic and ordinal regression models to identify associated risk factors and level of severity of the phenotypes.
Results:
Among 4427 children with asthma in this NSCH cohort, the association between race and phenotype was statistically significant (p < 0.0001); white children with asthma were most likely to have allergic-not-obese asthma while black and Hispanic children with asthma were most likely to have the obese-nonallergic phenotype (p < 0.001). Attention-deficit disorder/attention-deficit hyperactivity disorder was more likely to be present in allergic-not-obese children (odds ratio (OR) 1.50, confidence interval (CI) 1.14-1.98, p = 0.004). The phenotype with the highest risk for more severe compared to mild asthma was the obese-and-allergic asthma phenotype (OR 3.34, CI 2.23-5.01, p < 0.001).
Conclusions:
Allergic-not-obese asthma comprised half of our studied asthma phenotypes, while obesity-related asthma (with or without allergic components) comprised one-fifth of asthma phenotypes in this cohort representative of the US population. Children with both obese and allergic asthma are most likely to have severe asthma. Future management of childhood asthma might consider more tailoring of treatment and management plans based upon different childhood asthma phenotypes.
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