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

Published:December 19, 2017DOI:https://doi.org/10.1016/j.jaci.2017.09.043

      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.

      Key words

      Abbreviations used:

      AD (Asthma symptom days), BMI (Body mass index), ED (Emergency department), ICS (Inhaled corticosteroids), INFANT (Individualized Therapy for Asthma in Toddlers), LTRA (Leukotriene receptor antagonist), MIST (Maintenance versus Intermittent Inhaled Steroids in Wheezing Toddlers trial), NW (Normal weight), OW (Overweight/obese), PEAK (Prevention of Early Asthma in Kids trial), SABA (Short-acting β-2-agonists)
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