https://doi.org/10.4081/monaldi.2023.2581

Asthma exacerbations and body mass index in children and adolescents: experience from a tertiary care center

Vol. 94 No. 2 (2024)
Submitted: March 13, 2023
Accepted: June 8, 2023
Published: June 27, 2023
Body mass index, asthma exacerbation, lung volumes, obesity
Abstract Views: 771
PDF: 69
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.

Authors

Danish Abdul Aziz
drdanishaziz@gmail.com
https://orcid.org/0000-0001-5402-8488
Department of Pediatrics and Child Health, Aga Khan University Hospital, Karachi, Pakistan.
Rameen Ata Bajwa
https://orcid.org/0000-0002-7109-4871
Medical College, Aga Khan University, Karachi, Pakistan.
Werdah Viquar
Medical College, Aga Khan University, Karachi, Pakistan.
Fatima Siddiqui
https://orcid.org/0000-0002-6203-6856
Dr. Ruth K.M Pfau Civil Hospital, Karachi, Pakistan.
Aiza Abbas
Medical College, Aga Khan University, Karachi, Pakistan.

The prevalence and incidence of asthma continue to rise globally. Obesity has been identified as a potential risk factor for asthma exacerbations. The association between body mass index (BMI) and asthma is not well studied in some regions. This study aims to investigate the impact of BMI on pediatric asthmatic patients. This retrospective study was conducted at the Aga Khan University Hospital from 2019 to 2022. Children and adolescents with asthma exacerbations were included. The patients were classified into four groups based on their BMI: underweight, healthy weight, overweight, and obese. The demographic characteristics, medications used, predicted forced expiratory volume in 1 second (FEV1) measurements, asthma exacerbations per year, length of stay per admission, and the number of patients requiring high dependency unit (HDU) care were recorded and analyzed. Our results demonstrated that patients in the healthy weight category had the highest percentage of FEV1 (91.46±8.58) and FEV1/forced vital capacity (FVC) (85.75±9.23) (p<0.001). The study found a significant difference in the average number of asthma exacerbations per year between the four groups. Obese patients had the highest number of episodes (3.22±0.94), followed by the underweight group (2.42±0.59) (p<0.01). The length of stay per admission was significantly shorter for patients with a healthy weight (2.0±0.81), and there was a statistically significant difference observed in the number of patients requiring HDU care among the four groups, as well as in the average length of stay at the HDU (p<0.001). Elevated BMI is related to an increased number of annual asthma exacerbations, a low FEV1 and FEV1/FVC, an increased length of stay at admission, and an increased stay in the HDU.

Dimensions

Altmetric

PlumX Metrics

Downloads

Download data is not yet available.

Citations

Crossref
Scopus
Google Scholar
Europe PMC
Everaere L, Ait Yahia S, Bouté M, et al. Innate lymphoid cells at the interface between obesity and asthma. Immunology 2018;153:21-30.
Alhekail GA, Althubaiti A, AlQueflie S. The association between body mass index and frequency of emergency department visits and hospitalization for asthma exacerbation in a pediatric population. Ann Saudi Med 2017;37:415-9.
Quinto KB, Zuraw BL, Poon KYT, et al. The association of obesity and asthma severity and control in children. J Allergy Clin Immunol 2011;128:964-9.
Shan LS, Zhou QL, Shang YX. Bidirectional association between asthma and obesity during childhood and adolescence: a systematic review and meta-analysis. Front Pediatr 2020;8:576858.
Kim SH, Sutherland ER, Gelfand EW. Is there a link between obesity and asthma?. Allergy Asthma Immunol Res 2014;6:189-95.
Reyes-Angel J, Kaviany P, Rastogi D, Forno E. Obesity-related asthma in children and adolescents. Lancet Child Adolesc Health 2022;6:713-24.
Lang JE, Hossain J, Smith K, Lima JJ. Asthma severity, exacerbation risk, and controller treatment burden in underweight and obese children. J Asthma 2012;49:456-63.
Holguin F, Bleecker ER, Busse WW, et al. Obesity and asthma: an association modified by age of asthma onset. J Allergy Clin Immunol 2011;127:1486-93.e2.
Santamaria F, Montella S, Greco L, et al. Obesity duration is associated to pulmonary function impairment in obese subjects. Obesity 2011;19:1623-8.
Forno E, Lescher R, Strunk R, et al. Decreased response to inhaled steroids in overweight and obese asthmatic children. J Allergy Clin Immunol 2011;127:741-9.
Kang M, Sohn SJ, Shin MH. Association between body mass index and prevalence of asthma in Korean adults. Chonnam Med J 2020;56:62-7.
Luder E, Ehrlich RI, Lou WYW, et al. Body mass index and the risk of asthma in adults. Respir Med 2004;98:29-37.
Shore SA. Obesity and asthma: possible mechanisms. J Allergy Clin Immunol 2008;121:1087-93.
Huang YJ, Chu YC, Chen CW, et al. Relationship among genetic variants, obesity traits and asthma in the Taiwan Biobank. BMJ Open Respir Res 2022;9:e001355.
Han X, Zhu Z, Xiao Q, et al. Obesity-related biomarkers underlie a shared genetic architecture between childhood body mass index and childhood asthma. Commun Biol 2022;5:1098.
Cole TJ, Faith MS, Pietrobelli A, Heo M. What is the best measure of adiposity change in growing children: BMI, BMI %, BMI z-score or BMI centile?. Eur J Clin Nutr 2005;59:419-25.
National Center for Health Statistics. Vital and health statistics. Evaluation of alternative body mass index (BMI) metrics to monitor weight status in children and adolescents with extremely high BMI using CDC BMI-for-age growth charts. 2022. Available from: https://www.cdc.gov/nchs/data/series/sr_02/sr02-197.pdf.
Global Initiative for Asthma. 2022 GINA Main Report. Available from: https://ginasthma.org/gina-reports/. Accessed: 27/05/2023.
Rothe T, Spagnolo P, Bridevaux PO, et al. Diagnosis and management of asthma - The Swiss guidelines. Respiration 2018;95:364-80.
Forno E, Celedón JC. Predicting asthma exacerbations in children. Curr Opin Pulm Med 2012;18:63-9.
Graham BL, Steenbruggen I, Barjaktarevic IZ, et al. Standardization of spirometry 2019 update. An official American Thoracic Society and European Respiratory Society technical statement. Am J Respir Crit Care Med 2019;200:e70-88.
Peters U, Dixon AE, Forno E. Obesity and asthma. J Allergy Clin Immunol 2018;141:1169-79.
Ahmadizar F, Vijverberg SJH, Arets HGM, et al. Childhood obesity in relation to poor asthma control and exacerbation: a meta-analysis. Eur Respir J 2016;48:1063-73.
Okubo Y, Nochioka K, Hataya H, et al. Burden of obesity on pediatric inpatients with acute asthma exacerbation in the United States. J Allergy Clin Immunol Pract 2016;4:1227-31.
Negri E, Pagano R, Decarli A, La Vecchia C. Body weight and the prevalence of chronic diseases. J Epidemiol Community Health 1988;42:24-9.
Lusky A, Barell V, Lubin F, et al. Relationship between morbidity and extreme values of body mass index in adolescents. Int J Epidemiol 1996;25:829-34.
Forno E, Han YY, Mullen J, Celedón JC. Overweight, obesity, and lung function in children and adults-a meta-analysis. J Allergy Clin Immunol Pract 2018;6:570-81.e10.
Davidson WJ, Mackenzie-Rife KA, Witmans MB, et al. Obesity negatively impacts lung function in children and adolescents. Pediatr Pulmonol 2014;49:1003-10.
Aziz DA, Abbas A, Viquar W, Hussain AM. Association of vitamin D levels and asthma exacerbations in children and adolescents: experience from a tertiary care center. Monaldi Arch Chest Dis 2022;93:2230.
Luthe SK, Hirayama A, Goto T, et al. Association between obesity and acute severity among patients hospitalized for asthma exacerbation. J Allergy Clin Immunol Pract 2018;6:1936-41.e4.
Kattan M, Kumar R, Bloomberg GR, et al. Asthma control, adiposity, and adipokines among inner-city adolescents. J Allergy Clin Immunol 2010;125:584-92.
McGarry ME, Castellanos E, Thakur N, et al. Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma. Chest 2015;147:1591-8.
Han J, Nguyen J, Kim Y, et al. Effect of inhaled corticosteroid use on weight (BMI) in pediatric patients with moderate-severe asthma. J Asthma 2019;56:263-9.
Da Silva PL, De Mello MT, Cheik NC, et al. Interdisciplinary therapy improves biomarkers profile and lung function in asthmatic obese adolescents. Pediatr Pulmonol 2012;47:8-17.
Willeboordse M, Van De Kant KDG, Tan FES, et al. A multifactorial weight reduction programme for children with overweight and asthma: a randomized controlled trial. PLoS One 2016;11:e0157158.
Luna-Pech JA, Torres-Mendoza BM, Luna-Pech JA, et al. Normocaloric diet improves asthma-related quality of life in obese pubertal adolescents. Int Arch Allergy Immunol 2014;163:252-8.
Stenius-Aarniala B, Poussa T, Kvarnström J, et al. Immediate and long term effects of weight reduction in obese people with asthma: randomised controlled study. BMJ 2000;320:827-32.

Ethics approval

Approval was received by the Ethics Review Committee at Aga Khan University Hospital.

How to Cite

Aziz, Danish Abdul, Rameen Ata Bajwa, Werdah Viquar, Fatima Siddiqui, and Aiza Abbas. 2023. “Asthma Exacerbations and Body Mass Index in Children and Adolescents: Experience from a Tertiary Care Center”. Monaldi Archives for Chest Disease 94 (2). https://doi.org/10.4081/monaldi.2023.2581.
Copyright (c) 2023 The Author(s) Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.