Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids

Publication date: Available online 19 December 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Jason E. Lang, Anne M. Fitzpatrick, David T. Mauger, Theresa W. Guilbert, Daniel J. Jackson, Robert F. Lemanske, Fernando D. Martinez, Robert C. Strunk, Robert S. Zeiger, Wanda Phipatanakul, Leonard B. Bacharier, Jacqueline A. Pongracic, Fernando Holguin, Michael D. Cabana, Ronina A. Covar, Hengameh H. Raissy, Monica Tang, Stanley J. Szefler
BackgroundOverweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults.ObjectiveWe sought to describe the relationships between OW and asthma severity and response to ICS in preschool children.MethodsThis 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.ResultsWithin 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.ConclusionsIn 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.



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