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Original Research |

Does Age Impact the Obese Asthma Phenotype?Does Age Impact the Obese Asthma Phenotype?: Longitudinal Asthma Control, Airway Function, and Airflow Perception Among Mild Persistent Asthmatics

Jason E. Lang, MD; Jobayer Hossain, PhD; Anne E. Dixon, BMBCh, FCCP; David Shade, JD; Robert A. Wise, MD, FCCP; Stephen P. Peters, MD, PhD, FCCP; John J. Lima, PharmD; for the American Lung Association-Asthma Clinical Research Centers*
Author and Funding Information

From the Division of Pulmonology, Allergy and Immunology (Dr Lang), and the Center for Pharmacogenomics and Translational Research (Drs Lang and Lima), Nemours Children’s Clinic, Jacksonville, FL; The Center for Pediatric Research (Dr Hossain), Alfred I. DuPont Hospital of Children, Wilmington, and the Department of Food and Resource Economics (Dr Hossain), University of Delaware, Newark, DE; Pulmonary and Critical Care Medicine (Dr Dixon), University of Vermont College of Medicine, Burlington, VT; Johns Hopkins University School of Medicine (Mr Shade and Dr Wise), Baltimore, MD; and Wake Forest University School of Medicine (Dr Peters), Winston-Salem, NC.

Correspondence to: Jason E. Lang, MD, Division of Pulmonology, Allergy and Immunology, Center for Pharmacogenomics and Translational Research, Nemours Children’s Clinic, 807 Children’s Way, Jacksonville, FL 32207; e-mail: jelang@nemours.org

a

BMI percentile.

b

Raw BMI.

Standardized correlation coefficients are listed for nonobese and obese participants.

Data are presented as mean (SD) for quantitative variables and No. (%) for categorical variables, unless indicated otherwise. P value was determined by χ2, analysis of variance, or Kruskal Wallis test. ACQ = Asthma Control Questionnaire; ACQm = Asthma Control Questionnaire-modified (does not contain FEV1 component); ASUI = Asthma Symptoms Utility Index; BD = postbronchodilator; EBC = exhaled breath condensate; FSC = flutacisone salmeterol combination; PFvar = peak flow variability.

a

Defined as presence of allergic rhinitis, eczema, or food allergy.

b

Reporting that allergic rhinitis made asthma worse.

Data are presented as least square mean (SE). Nonobese group includes lean and overweight participants. See Table 3 legend for expansion of abbreviations.

No difference means that there was no significant statistical or clinical difference between obese and nonobese asthmatics for a given outcome by age group. See Table 3 legend for expansion of abbreviations.

a

Airflow perception describes the ratio between asthma symptoms (measured by ACQm) and PFvar.

*

A complete list of the American Lung Association Asthma Clinical Research Centers can be found in e-Appendix 1.

Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline, which also supplied drugs and placebos for the parent trial, and a grant from the American Lung Association.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


A complete list of the American Lung Association Asthma Clinical Research Centers can be found in e-Appendix 1.

A complete list of the American Lung Association Asthma Clinical Research Centers can be found in e-Appendix 1.

Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline, which also supplied drugs and placebos for the parent trial, and a grant from the American Lung Association.

Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline, which also supplied drugs and placebos for the parent trial, and a grant from the American Lung Association.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


Chest. 2011;140(6):1524-1533. doi:10.1378/chest.11-0675
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Background:  The relationship between obesity and asthma remains inadequately defined. Studies about how obesity affects asthma control and lung function show conflicting results. Additional focus on the effect of age as a modifier may make clearer the interaction between obesity and asthma phenotype. We sought to use a diverse and well-phenotyped cohort of asthmatic patients to determine how age impacts the relationship between obesity and spirometry, peak flow variability, airflow perception, and asthma control.

Methods:  The characteristics of 490 patients with mild persistent asthma taken from 2,794 study visits from a prospective trial studying strategies of step-down therapy were included in this post hoc analysis. A longitudinal mixed-effect model was used to determine if age affects the relationship between obesity and asthma characteristics, including spirometry, asthma control, airway pH, and perception of airflow changes.

Results:  The effect of obesity on asthma outcomes changes with age and gender. Obese 6- to 11-year-old children had the largest reduction in lung function but reported relatively fewer asthma symptoms than did similar nonobese asthmatics. Obese 12- to 17-year-olds showed a trend toward greater airflow obstruction and asthma symptoms compared with nonobese asthmatics. Adults in general displayed few obesity-related alterations in asthma phenotype. Female gender among 12- to 17- and 18- to 44-year-olds was associated with greater obesity-related asthma impairment.

Conclusions:  Age is a significant effect modifier on the relationship between obesity and asthma phenotype. With increasing age, the influence of obesity on the asthma phenotype is generally reduced. The asthma phenotype may be most impacted by obesity among children and women.

Trial registry:  ClinicalTrials.gov; No.: NCT00156819; URL: www.clinicaltrials.gov

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