Severity of childhood asthma among normal, overweight and obese children - a comparative study

INTRODUCTION: Obesity is a systemic inflammatory state affecting various organs including lungs. The rising prevalence of asthma and obesity among children has led to hypothesis of causality of obesity in development of asthma.
METHODS: 150 asthmatic children meeting the diagnostic criteria were enrolled for this study. Thorough clinical and anthropometric examination was done. The children were then categorized into two groups based on BMI as those with normal BMI and overweight/obesity. They were then followed up over 12 months and information collected was analyzed.
RESULTS: Of the 150 children, 72% were male and 45.3% belonged to the age group of 6-11 years. In 46.7%, asthma was diagnosed <5 years. 50% of the children missed school for 1-5 days in a year. Majority(63.3%) of the asthmatic children were able to perform the same level of physical activity as their peers. 54% of the asthmatic children had mild persistent asthma. Overweight/obesity was present in 19.3% of participants. Majority(72.4%) of the obese asthmatic children were diagnosed <12 years and had moderate-severe persistent asthma. Asthmatic children with overweight/obesity had higher night awakenings and missed school days at enrolment and follow up. Overweight/obese asthmatic children visited the emergency, required rescue medications and received steroids more often than children with normal BMI.
DISCUSSION AND CONCLUSION: Obese asthma is a well defined phenotype of childhood asthma characterized by higher disease burden and poor response to treatment. Hence a bipronged strategy to tackle overweight/obesity and control asthma in this group is warranted. Children with overweight/obesity and asthma have higher number of emergency visits, hospitalizations and use of rescue medications. Hence strategies directed towards reduction of obesity at an early age may help reduce the severity of asthma.