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Asthma symptoms in obese children have a unique inflammatory basis

Published: October 21, 2021

The prevalence of obesity is increasing in children in the United States and is disproportionately higher in children with asthma. Obesity is not only a potential risk factor for asthma onset but is also a risk factor for greater asthma morbidity in affected children. Yet despite the important influence of obesity on asthma outcomes, studies in children remain quite limited, with few attempts to characterize systemic inflammation in these patients.

In this issue of The Journal of Allergy and Clinical Immunology: In Practice, Fitzpatrick and colleagues examined asthma outcomes over 12 months of follow-up and after a supervised intramuscular corticosteroid intervention in a well-characterized cohort of children ages 6-17 years classified as either lean (N=257), overweight (N=99) and obese (N=138) according to age- and sex-specific body mass index percentile growth charts from the Centers for Disease Control and Prevention. Outcome measures included asthma control, quality of life, lung function, and exacerbations treated with systemic corticosteroids. Leptin, adiponectin, C-reactive protein, total cholesterol, IL-1, IL-6, IL-17, IFN, TNF, MCP-1, and amino acid metabolites were also quantified in plasma as potential biomarkers of outcomes in obese children.

Obesity was associated with more symptoms, poorer quality of life, and more exacerbations at enrollment; these features persisted over one year despite greater asthma medication requirements. Obese children also had minimal clinical improvement in asthma control and lung function after intramuscular corticosteroid intervention. Leptin and C-reactive protein concentrations were higher in obese children while concentrations of IFN and IL-17 were lower. Obese children with asthma also had differing amino acid metabolites associated with glutathione synthesis and oxidative stress. Within the obese group, lower concentrations of arginine-related metabolites also distinguished uncontrolled from controlled asthma at 12 months. These results suggest that obesity is associated with poorer asthma outcomes and unique systemic inflammatory features that may not be adequately modified with conventional asthma therapies. Novel approaches may be needed given increased symptoms and unique patterns of inflammation and oxidative stress in obese children with asthma.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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