Weight gain in childhood could worsen asthma in later years

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A new study finds that children with asthma that became obese by their 20s experienced increased airway obstruction-but without worsening symptoms.

Physicians should pay close attention to weight gain in children with asthma, because it could result in increased airway obstruction as they age, according to a new report published in the Journal of Allergy and Clinical Immunology.

Obesity and asthma are both on the rise, and several studies have linked the development of obesity during school-age years to a higher prevalence of asthma in adolescence.

Obesity has previously been linked to asthma, but in terms of development rather than the disease worsening. A study published in the Annals of Allergy, Asthma and Immunology last year estimated that for each extra unit of body mass index, the risk of developing asthma increased 55%.

Weight gain can also worsen the symptoms of asthma, according to the newer study, and make it harder to control with medication-obese asthmatics have a greater need for albuterol and oral corticosteroids, and have a decreased response to inhaled corticosteroids.

The study confirmed that children ages 5 to 12 with mild to moderate asthma who were not obese but became that way by the time they reached their 20s had increased airway obstruction compared to their non-obese peers. Both FEV₁ and FEV₁/FVC were significantly lower in the obese group, according to the study.

Despite the clinical worsening of asthma related to the development of obesity, the study reveals that the cohort that became obese over the study period did not report worsening asthma symptoms or increased reliance on prednisone. Previous studies found worsening symptoms in obese older adults, and the study authors estimate that while the children in this cohort were obese, their body mass index-while high-was not enough to effect symptoms.

Physiologically, obesity was believed to worsen asthma as a result of a restrictive ventilator defect, but the study authors believe there may be the result of inflammatory markers in the lung tissue itself. The study was unable to state this conclusively, however, because no inflammatory markers were collected over the course of the study.

Lead author Robert Strunk, MD, a pediatric pulmonologist at St. Louis Children’s Hospital, says his study supports early counseling and education on obesity in pediatric asthma patients. Although heavy doses of prednisone could result in weight gain, the cases in this study were not due to medications. Physicians must recognize weight gain early on and address it with patients, stressing the many negative outcomes that could result from obesity.

“Physicians are increasingly aware of obesity. They are frustrated by it because there’s really not good treatment for it,” Strunk told Medical Economics.

In children, especially, managing weight gain can be a challenge because it becomes a family affair.

“It’s clearly a family issue, and it’s not only a family issue in terms of recognizing it’s there and being willing to want to take some action, but the treatment for obesity includes the whole family,” Strunk says. “The whole family has to get out and walk or eat more sensibly.”