TY - JOUR
T1 - Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids
AU - National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet
AU - Lang, Jason E.
AU - Fitzpatrick, Anne M.
AU - Mauger, David T.
AU - Guilbert, Theresa W.
AU - Jackson, Daniel J.
AU - Lemanske, Robert F.
AU - Martinez, Fernando D.
AU - Strunk, Robert C.
AU - Zeiger, Robert S.
AU - Phipatanakul, Wanda
AU - Bacharier, Leonard B.
AU - Pongracic, Jacqueline A.
AU - Holguin, Fernando
AU - Cabana, Michael D.
AU - Covar, Ronina A.
AU - Raissy, Hengameh H.
AU - Tang, Monica
AU - Szefler, Stanley J.
N1 - Publisher Copyright:
© 2017 American Academy of Allergy, Asthma & Immunology
PY - 2018/4
Y1 - 2018/4
N2 - Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.
AB - Background: Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults. Objective: We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children. Methods: This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups. Results: Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P =.020) and exacerbations (1.4 vs 0.8, P =.009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P =.44; short-term ICS: 61.8 vs 52.9 days, P =.46; as-needed ICS: 53.3 vs 47.3 days, P =.53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P =.10; short-term ICS: 1.1 vs 0.8 days, P =.25; as-needed ICS: 1.0 vs 1.1, P =.72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P =.004) and exacerbations (1.4 vs 0.6, P =.006), while similar protective ICS effects were less apparent among NW. Conclusions: In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.
KW - Asthma
KW - children
KW - exacerbation
KW - infants
KW - obesity
KW - overweight
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U2 - 10.1016/j.jaci.2017.09.043
DO - 10.1016/j.jaci.2017.09.043
M3 - Article
C2 - 29273557
AN - SCOPUS:85038632109
SN - 0091-6749
VL - 141
SP - 1459-1467.e2
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 4
ER -