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Obese kids more likely to have worse asthma with school NO2 exposure

Published online: March 17, 2020

Obesity and asthma are two chronic childhood disorders that have shown a striking surge in prevalence over the past two decades, particularly in inner-city children. There is a higher incidence and severity of asthma in obese populations leading many to investigate the link between these two conditions. One theory is that obesity-related inflammation may lead to exaggerated lung responses to environmental triggers and subsequent asthma symptoms. We know that nitrogen dioxide (NO2), one of the best studied indoor home pollutants, is associated with increased asthma symptoms in children. Little data exists, however, addressing the effects of classroom NO2 exposure on obese students with asthma.  

In an article recently published in the The Journal of Allergy and Clinical Immunology (JACI), Permaul and colleagues examined the relationships between classroom NO2 levels and asthma outcomes by body mass index (BMI) stratification – obese, overweight, and normal weight. The authors analyzed data collected from students with asthma, between the ages of 4-13 years, attending urban schools enrolled in the School Inner-City Asthma Study (SICAS). Students had baseline determination of BMI percentile and asthma morbidity measures were monitored throughout the subsequent academic year.

The authors found that higher concentrations of classroom NO2 exposure was associated with increased asthma symptoms and a greater effect on caregiver plans due to child’s asthma among the obese students, but not among normal weight children. Among obese participants, increasing NO2 levels was also associated with an increase in healthcare use for asthma-related symptoms and more missed school days due to asthma. Findings suggest that obese inner-city children with asthma are more susceptible to the respiratory health effects of indoor NO2 exposure in school classrooms.

The authors conclude that obese BMI status and the school environment should be taken into consideration when assessing childhood asthma risk factors. Obese inner-city students with asthma might benefit the most from reductions in classroom NO2 levels. Further research is needed to fully understand the biologic mechanisms for why obese children with asthma appear to be more vulnerable to the effects of indoor pollutant exposure.

The Journal of Allergy and Clinical Immunology (JACI) is an official scientific journal of the AAAAI, and is the most-cited journal in the field of allergy and clinical immunology.