PURPOSE: Epidemiological data indicates a relationship between obesity and asthma. Obesity has been identified as a risk factor for asthma during early childhood. Whether, the obesity also impacts asthma control and the response to standard asthma therapeutics in urban Indian setting, we planned this study.
METHODS: School going asthmatic children aged 8 to 18 years were enrolled into two study groups- Group (A) asthmatic children with normal BMI; Group (B) asthmatic children with BMI greater than for their age & sex. Both the groups were compared on various parameters i.e. asthma severity, asthma control and response to standard asthma therapy using clinical asthma severity score, asthma control questionnaire score,and pulmonary function testing.
RESULTS: Of the 77 School going children with asthma (51 male and 26 female), 46 patients constituted Group A and 31 Group B. Asthma symptoms and especially nocturnal cough was significantly more common in Group B patients having higher BMI; OR 1.50 (95% CI 1.03 to 2.20) (p value 0.035). Gastro-esophageal reflux disease was more commonly associated with obese asthmatic children (38.7% Vs 19.1%, p value <0.001).FEV1 was also significantly lower in Group B patients than Group A patients; OR 2.04 (95% CI 1.23 to 3.36). The mean asthma control score was 2.2±0.6 in Group A and 2.9±0.7 in Group B (p value 0.02). More than half of Group B patients (57.1%) required oral montelukast as add on therapy to standard treatment for asthma control. This association was more in obese male children than obese female children (p value 0.001).
CONCLUSION: Asthma is not only more common among obese children but also more severe, especially in males. Asthma also appears to be more difficult to control in obese than lean asthmatic children. Gastro-esophageal reflux disease is also observed to be more common in obese asthmatic children.
CLINICAL IMPLICATIONS: Montelukast may be considered for better asthma control in overweight children. Treatment of such patients should always include a Weight Control Programme and control of co morbid conditions i.e.Gastro-esophageal reflux disease.
DISCLOSURE: Ramakant Dixit, No Financial Disclosure Information; No Product/Research Disclosure Information