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Respiratory infections worse for asthmatics who are obese

Published online: October 9, 2018

Asthma is one of the most common chronic respiratory diseases and is frequently poorly controlled. Respiratory infections trigger most asthma exacerbations. Obesity has been linked to poorly controlled asthma and increased respiratory tract infections. Understanding the effect of obesity on respiratory infections in patients with asthma could help identify new treatment strategies.   

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Tang and colleagues performed a post-hoc analysis of five large randomized controlled trials performed by the American Lung Association – Airways Clinical Research Center involving 747 children and 1287 adults. The authors used univariable and multivariable negative binomial regression to compare the rate of visits with respiratory tract infections in lean, overweight, and obese participants. Secondary asthma outcomes included upper respiratory infection severity, systemic steroid use, and healthcare contact.  

The rate of visits with respiratory tract infections did not differ in lean, overweight, or obese children or adults with asthma. However, in adults, overweight and obese participants reported more moderate/severe upper respiratory infections, higher rates of infection-associated asthma exacerbations requiring systemic steroids, and higher rates of infection-associated healthcare contact. In adjusted models, the rate of respiratory tract infections in patients with asthma was increased in children compared to adults, children on a Proton pump inhibitor (PPI) compared to those not on a PPI, and adults with atopy compared to those without atopy.  

Though obesity did not appear to increase the risk for Respiratory tract infection (RTI), in adults it did increase infection-associated asthma morbidity. Adults with obesity and asthma may have worse control due to more severe respiratory infections and subsequent exacerbations.  Obese patients with asthma may improve their asthma control by targeting weight reduction and prevention of respiratory tract infections.

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