Decreased response to inhaled steroids in overweight and obese asthmatic children - 10/08/11
, Rachel Lescher, MD e, Robert Strunk, MD f, Scott Weiss, MD, MS a, d, Anne Fuhlbrigge, MD, MPH a, b, d, Juan C. Celedón, MD, DrPH a, b, dChildhood Asthma Management Program Research Group
Reprint requests: Erick Forno, MD, MPH, Batchelor Children’s Research Institute, University of Miami, 1580 NW 10th Ave #125, Miami, FL 33136.Abstract |
Background |
The mechanisms and consequences of the observed association between obesity and childhood asthma are unclear.
Objectives |
We sought to determine the effect of obesity on treatment responses to inhaled corticosteroids in asthmatic children.
Methods |
We performed a post hoc analysis to evaluate the interaction between body mass index (BMI) and treatment with inhaled budesonide on lung function in the Childhood Asthma Management Program trial. Participants were then stratified into overweight/obese and nonoverweight groups, and their response to inhaled budesonide was analyzed longitudinally over the 4 years of the trial.
Results |
There was a significant interaction between BMI and budesonide for prebronchodilator FEV1/forced vital capacity (FVC) ratio (P = .0007) and bronchodilator response (BDR; P = .049) and a nonsignificant trend for an interaction between BMI and budesonide on prebronchodilator FEV1 (P = .15). Nonoverweight children showed significant improvement with inhaled budesonide in lung function (FEV1, FEV1/FVC ratio, and BDR) during the early (years 1-2) and late (years 3-4) stages of the trial. Overweight/obese children had improved FEV1 and BDR during the early but not the late stage of the trial and showed no improvement in FEV1/FVC ratio. When comparing time points at which both groups showed a significant response, the degree of improvement among nonoverweight children was significantly greater than in overweight/obese children at most visits. Nonoverweight children had a 44% reduction in the risk of emergency department visits or hospitalizations throughout the trial (P = .001); there was no reduction in risk among overweight/obese children (P = .97).
Conclusions |
Compared with children of normal weight, overweight/obese children in the Childhood Asthma Management Program showed a decreased response to inhaled budesonide on measures of lung function and emergency department visits/hospitalizations for asthma.
Le texte complet de cet article est disponible en PDF.Key words : Asthma, obesity, pediatric asthma, childhood obesity, budesonide
Abbreviations used : BDR, BMI, CAMP, ED, FVC, GR
Plan
| The Childhood Asthma Management Program (CAMP) trial and CAMP Continuation Study were supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources. |
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| Disclosure of potential conflict of interest: A. Fuhlbrigge is a consultant for Genentech, Novartis, and the Lovelace Respiratory Research Institute and serves on respiratory specialist advisory panels for Sunovion and Merck. The rest of the authors have declared that they have no conflict of interest. |
Vol 127 - N° 3
P. 741-749 - mars 2011 Retour au numéro
Article précédent
- Parental psychosocial stress and asthma morbidity in Puerto Rican twins
- Nancy E. Lange, Supinda Bunyavanich, Judy L. Silberg, Glorisa Canino, Bernard A. Rosner, Juan C. Celedón
- Interleukin-1 receptor–like 1 polymorphisms are associated with serum IL1RL1-a, eosinophils, and asthma in childhood
- Olga E.M. Savenije, Marjan Kerkhof, Naomi E. Reijmerink, Bert Brunekreef, Johan C. de Jongste, Henriëtte A. Smit, Alet H. Wijga, Dirkje S. Postma, Gerard H. Koppelman
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