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Preschool children with obesity, asthma benefit from inhaled corticosteroids
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Children between the ages of 2 and 5 years with overweight or obesity experience asthma symptoms and exacerbations more frequently than children of the same age with normal weight; however, inhaled corticosteroids can reduce the annual symptom days and exacerbations experienced by this demographic.
“The impact of overweight and obesity on asthma has not been studied in the youngest asthma patients, and this finding is the opposite of what has been seen in older kids and adults who are overweight,” Jason Lang, MD, a pediatric lung specialist and director of the Duke Children’s Pulmonary Function Laboratory, said in a press release.
“Reports in older children and adults with asthma who are overweight have shown a poor response to inhaled corticosteroids to manage their asthma,” he continued. “This study suggests either pathways of inflammation are a bit different in preschool-aged patients or that it takes years for obesity to reduce the effectiveness of steroid inhalers.”
To explain the connection between asthma severity and response to inhaled corticosteroids in preschool children with overweight or obesity, the researchers conducted a post hoc study that included three large multicenter trials. All children included in these studies were aged between 2 and 5 years. Lang and colleagues assessed the number of annualized asthma symptom days and exacerbations in children with normal weight and then compared them with those of children with overweight or obesity.
The researchers defined normal weight as having a body mass index between the 10th and 84th percentiles. Children with overweight or obesity were defined as those with a body mass index at or above the 85th percentile. All children included in the study were administered daily inhaled corticosteroids, intermittent inhaled corticosteroids or a daily placebo. Body mass index groups were later examined using simple and multivariable linear regression.
Of the children who were not given a daily controller medication, preschool children with overweight or obesity experienced asthma symptoms on more days (90.7 vs. 53.2; P = .020) in addition to more exacerbations (1.4 vs. 0.8; P = .009) when compared with children with normal weight. When administered daily inhaled corticosteroids, similar results were observed between children with overweight or obesity and children with normal weight (daily ICS: 47.2 vs. 44.0 days; short term ICS: 61.8 vs. 52.9 days;; as-needed ICS: 53.3 vs. 47.3 days).
Regardless of body mass index, preschool children who were given inhaled corticosteroids also had similar exacerbation rates (daily ICS: 0.6 vs. 0.8 days; P = .10; short-term ICS: 1.1 vs. 0.8 days; as-needed ICS: 1.0 vs. 1.1 days). Children with overweight or obesity had fewer annualized asthma symptom days when receiving an inhaled corticosteroid compared with placebo (90.7 vs. 41.2, P = .004); however, children with normal weight did not experience the same level of protectiveness with inhaled corticosteroids.
“This study uses the best, most highly controlled data to demonstrate that early-life weight gain does worsen the severity of asthma in the youngest patients,” Lang said in the release. “Weight does not hamper the effectiveness of inhaled steroids in preschoolers, but this study provides clear evidence that maintaining a healthy weight in preschoolers may be an effective strategy for controlling asthma.” – by Katherine Bortz
Disclosures: Lang’s institution received a grant from NHLBI for this work and grants from NHLBI and Hartwell Foundation for other works. Lang reports receiving consultancy fees from University of Connecticut and travel expenses from the American Lung Association. Please see the study for all other authors’ relevant financial disclosures.
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