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Randomized Controlled Trial
. 2013 Sep;48(9):847-56.
doi: 10.1002/ppul.22707. Epub 2012 Nov 9.

Obesity in children with poorly controlled asthma: Sex differences

Jason E Lang  1 , Janet T Holbrook, Robert A Wise, Anne E Dixon, W Gerald Teague, Christine Y Wei, Charles G Irvin, David Shade, John J Lima; American Lung Association-Asthma Clinical Research Centers
Collaborators, Affiliations
Randomized Controlled Trial

Obesity in children with poorly controlled asthma: Sex differences

Jason E Lang et al. Pediatr Pulmonol. 2013 Sep.

Abstract

Background: Obesity increases asthma risk, and may alter asthma severity. In adults, sex appears to modify the effect of obesity on asthma. Among children, the effect of sex on the relationship between obesity and asthma severity remains less clear, particularly when considering race.

Objective: To determine how obesity affects disease characteristics in a diverse cohort of children with poorly controlled asthma, and if obesity effects are altered by sex.

Design: We analyzed 306 children between 6 and 17 years of age with poorly controlled asthma enrolled in a 6-month trial assessing lansoprazole for asthma control. In this secondary analysis, we determined associations between obesity and symptom severity, spirometry, exacerbation risk, airway biomarkers, bronchial reactivity, and airflow perception. We used both a multivariate linear regression and longitudinal mixed-effect model to determine if obesity interacted with sex to affect asthma severity.

Results: Regardless of sex, BMI >95th percentile did not affect asthma control, exacerbation risk or airway biomarkers. Sex changed the effect of obesity on lung function (sex × obesity FEV1%, interaction P-value < 0.01, sex × obesity FEV1/FVC, interaction P-value = 0.03). Obese males had significantly worse airflow obstruction compared to non-obese males, while in females there was no obesity effect on airflow obstruction. In females, obesity was associated with significantly greater FEV1 and FVC, and a trend toward reduced airway reactivity.

Conclusions: Obesity did not affect asthma control, airway markers or disease stability; however obesity did affect lung function in a sex-dependent manner. In males, obesity associated with reduced FEV1/FVC, and in females, obesity associated with substantially improved lung function.

Keywords: asthma; body mass index; children; obesity; sex; spirometry.

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Conflict of interest statement

COMPETING INTERESTS

Disclosures:

Dr. Lang has no conflicts of interest in the subject matter of this manuscript

Dr. Holbrook has no conflicts of interest in the subject matter of this manuscript

Dr. Wise has no conflicts of interest in the subject matter of this manuscript

Dr. Dixon has no conflicts of interest in the subject matter of this manuscript

Dr. Teague has no conflicts of interest in the subject matter of this manuscript

Ms. Wei has no conflicts of interest in the subject matter of this manuscript

Dr. Irvin has no conflicts of interest in the subject matter of this manuscript

Dr. Shade as no conflicts of interest in the subject matter of this manuscript

Dr. Lima has no conflicts of interest in the subject matter of this manuscript

Figures

Figure 1
Figure 1
Differential Obesity-Effect by Sex. FEV1 percent predicted point difference and FEV1/FVC percentage difference when comparing obese to non-obese children by sex. Boys (n=175), Girls (n=115). Row below graph shows the interaction p-value for the effect of sex on the relationship between obesity status and asthma outcomes. FEV1 – forced expiratory volume in 1 second, FVC – forced vital capacity.
Figure 2
Figure 2
Obesity and Asthma Severity in White Male Children. Pre-bronchodilator [non-obese (n=52) and obese (n=19)] and post-bronchodilator [non-obese (n=50) and obese (n=19)] spirometry (left panel). Disease severity based on Asthma Control Questionnaire and Peak Flow Variability prior to randomization [non-obese (n=52), obese (n=19) (right panel); FEV1-forced expiratory volume in 1 second (percent predicted), FVC – forced vital capacity, PFvar – peak flow variability, ACQ – asthma control questionnaire, * - p ≤ .05, ** - p < .01.
See this image and copyright information in PMC

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