Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids - 05/04/18
, Anne M. Fitzpatrick, PhD b, David T. Mauger, PhD c, Theresa W. Guilbert, MD e, Daniel J. Jackson, MD f, Robert F. Lemanske, MD g, Fernando D. Martinez, MD h, Robert C. Strunk, MD i, †, Robert S. Zeiger, MD, PhD j, Wanda Phipatanakul, MD, MS l, Leonard B. Bacharier, MD i, Jacqueline A. Pongracic, MD m, Fernando Holguin, MD d, Michael D. Cabana, MD k, Ronina A. Covar, MD n, Hengameh H. Raissy, PharmD p, Monica Tang, MD a, Stanley J. Szefler, MD, PhD ofor the
National Institutes of Health/National Heart, Lung and Blood Institute AsthmaNet
Abstract |
Background |
Overweight/obesity (OW) is linked to worse asthma and poorer inhaled corticosteroid (ICS) response in older children and adults.
Objective |
We sought to describe the relationships between OW and asthma severity and response to ICS in preschool children.
Methods |
This post hoc study of 3 large multicenter trials involving 2- to 5-year-old children compared annualized asthma symptom days and exacerbations among normal weight (NW) (body mass index: 10th-84th percentiles) versus OW (body mass index: ≥85th percentile) participants. Participants had been randomized to daily ICS, intermittent ICS, or daily placebo. Simple and multivariable linear regression was used to compare body mass index groups.
Results |
Within the group not treated with a daily controller, OW children had more asthma symptom days (90.7 vs 53.2, P = .020) and exacerbations (1.4 vs 0.8, P = .009) thanNW children did. Within the ICS-treated groups, OW and NW children had similar asthma symptom days (daily ICS: 47.2 vs 44.0 days, P = .44; short-term ICS: 61.8 vs 52.9 days, P = .46; as-needed ICS: 53.3 vs 47.3 days, P = .53), and similar exacerbations (daily ICS: 0.6 vs 0.8, P = .10; short-term ICS: 1.1 vs 0.8 days, P = .25; as-needed ICS: 1.0 vs 1.1, P = .72). Compared with placebo, daily ICS in OW led to fewer annualized asthma symptom days (90.7 vs 41.2, P = .004) and exacerbations (1.4 vs 0.6, P = .006), while similar protective ICS effects were less apparent among NW.
Conclusions |
In preschool children off controller therapy, OW is associated with greater asthma impairment and exacerbations. However, unlike older asthmatic patients, OW preschool children do not demonstrate reduced responsiveness to ICS therapy.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, overweight, obesity, children, infants, exacerbation
Abbreviations used : AD, BMI, ED, ICS, INFANT, LTRA, MIST, NW, OW, PEAK, SABA
Plan
| Funded by the National Heart, Lung, and Blood Institute (NHLBI) AsthmaNet. |
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| Disclosure of potential conflict of interest: J. E. Lang's institution received a grant from NHLBI for this work and grants from NHLBI and Hartwell Foundation for other works; he personally received consultancy fees from University of Connecticut, and travel expenses from American Lung Association. A. Fitzpatrick's institution received a grant from NHLBI for this work. D. T. Mauger's institution received a grant from NHLBI for this manuscript, and received donated medications from GlaxoSmithKline, Merck, and Astra-Zeneca for this work. T. W. Guilbert received personal fees from American Board of Pediatrics, Pediatric Pulmonary Subboard, Teva Pharmaceutical Industries, GlaxoSmithKline, Regeneron Pharmaceuticals, Merck, Sanofi, Novartis, and Aviragen; a grant from the National Institutes of Health (NIH); and royalties from UpToDate. D. Jackson's institution received a grant from NHLBI for this work; he personally received consultancy fees from Boehringer Ingelheim, GlaxoSmithKline, Novartis, and Commense; his institution received a grant from the National Institute of Allergy and Infectious Diseases for other works. R. F. Lemanske Jr's institution received a grant from NHLBI for this work and grants from NHLBI and Pharmaxis for other works; he personally received payment for writing or reviewing this manuscript as well as financial support for administrative assistance from NHLBI; has board membership from American Academy of Allergy, Asthma, and Immunology; is employed by University of Wisconsin School of Medicine and Public Health; received payments for lectures from Asthma and Allergy Foundation of America–Alaska Chapter, Egyptian Allergy Society, and Louisiana State University; and royalties from Elsevier and UpToDate. F. Martinez's institution received NIH/NHLBI grants HL064307 and HL09112 for this work and NIH/NHLBI grants, NIH/National Institute of Environmental Health Sciences, NIH/Office of the Director, and Johnson & Johnson grants for other works. R. S. Zeiger's institution received a grant from NHLBI for this work and grants from MedImmune, Merck, Aerocrine, and Genentech for other works; he personally received consultancy fees from AstraZeneca, Genentech, Novartis, Teva Pharmaceutical Industries, GlaxoSmithKline, Theravance BioPharma, Regeneron Pharmaceuticals, and Patara Pharma. L. B. Bacharier received a grant from NIH/NHBLI for this work; personally received consultancy fees from Aerocrine, GlaxoSmithKline, Genentech/Novartis, Merck, Cephalon, Teva Pharmaceutical Industries, Boehringer Ingelheim, AstraZeneca, and WebMD/Medscape; serves on the advisory boards of DBV Technologies, Sanofi, Vectura, and Circassia. J. A. Pongracic's institution received a grant and support for travel from NHLBI for this work; the institution received drugs from Novartis and GlaxoSmithKline for other works. M. D. Cabana received consultancy fees from Genentech, Novartis, and Thermo-Fisher; and payment for lectures from Merck. R. A. Covar's institution received grants from AstraZeneca and Roche for this work. H. H. Raissy's institution received grants from NHLBI: AsthmaNet, CARE network, and NIH: Institutional Development Awards States Pediatric Clinical Trials Network for this work. M. Tang's institution received grant NIH T32 AI007062-38 for other work. S. Szefler's institution received a grant from National Institute of Allergy and Infectious Disease–Inner City Asthma Consortium for this work; consultancy fees from Boehringer-Ingelheim, Genentech, GlaxoSmithKline, Aerocrine, Novartis, Astra Zeneca, Daiichi Sankyo, Roche, and Teva Pharmaceutical Industries; and grants from GlaxoSmithKline for other works; he personally received consultancy fees from Merck. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 141 - N° 4
P. 1459 - avril 2018 Retour au numéro
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