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Original Research: Asthma |

Obesity and Bronchodilator Response in Black and Hispanic Children and Adolescents With AsthmaObesity and Bronchodilator Response in Asthma

Meghan E. McGarry, MD; Elizabeth Castellanos, BS; Neeta Thakur, MD, MPH; Sam S. Oh, PhD, MPH; Celeste Eng, BS; Adam Davis, MA; Kelley Meade, MD; Michael A. LeNoir, MD; Pedro C. Avila, MD; Harold J. Farber, MD, MSPH, FCCP; Denise Serebrisky, MD; Emerita Brigino-Buenaventura, MD; William Rodriguez-Cintron, MD; Rajesh Kumar, MD, MSPH; Kirsten Bibbins-Domingo, PhD, MD; Shannon M. Thyne, MD; Saunak Sen, PhD; Jose R. Rodriguez-Santana, MD; Luisa N. Borrell, DDS, PhD; Esteban G. Burchard, MD, MPH
Author and Funding Information

From the Department of Pediatrics (Drs McGarry and Thyne), the Department of Bioengineering and Therapeutic Sciences (Ms Castellanos and Drs Oh, Sen, and Burchard), the Department of Medicine (Drs Thakur, Oh, and Burchard and Ms Eng), and the Department of Epidemiology and Biostatistics (Dr Sen), University of California, San Francisco, CA; The Children’s Hospital and Research Center Oakland (Mr Davis and Dr Meade), Oakland, CA; Bay Area Pediatrics (Dr LeNoir), Oakland, CA; the Department of Allergy-Immunology (Dr Avila), Northwestern University, Chicago, IL; the Department of Pediatrics (Dr Farber), Section of Pulmonology, Baylor College of Medicine and Texas Children’s Hospital, Houston, TX; the Pediatric Pulmonary Division (Dr Serebrisky), Jacobi Medical Center, Bronx, NY; the Department of Allergy and Immunology (Dr Brigino-Buenaventura), Kaiser Permanente-Vallejo Medical Center, Vallejo, CA; Veterans Caribbean Health Care System (Dr Rodriguez-Cintron), San Juan, Puerto Rico; The Ann and Robert H. Lurie Children’s Hospital of Chicago (Dr Kumar), Chicago, IL; San Francisco General Hospital (Dr Bibbins-Domingo), San Francisco, CA; Centro de Neumología Pediátrica (Dr Rodriguez-Santana), San Juan, Puerto Rico; and the Department of Health Sciences (Dr Borrell), Lehman College, City University of New York, Bronx, NY.

CORRESPONDENCE TO: Meghan E. McGarry, MD, Department of Pediatrics, University of California, San Francisco, 550 16th St, 5th Floor, Box 0632, San Francisco, CA 94158; e-mail: DrMeghanMcGarry@gmail.com


Drs Borrell and Burchard share senior authorship of this article.

FUNDING/SUPPORT: This study was supported in part by grants from the National Institutes of Health [R01-ES015794, U19-AI077439, R01-HL088133, R01-HL078885, and R01-HL104608]; the National Institute on Minority Health and Health Disparities of the National Institutes of Health under Award Number [P60-MD006902]; the National Center for Research Resources (to Dr Farber [M01-RR00188]); the Flight Attendant Medical Research Institute (FAMRI); the Sandler Foundation; the RWJF Amos Medical Faculty Development Award (to Dr Burchard); the American Asthma Foundation (to Dr Burchard); and the Ernest S. Bazley Grant (to Dr Avila). Dr Thakur was supported by an institutional training grant from the National Institute of General Medical Sciences [T32-GM007546]. Dr McGarry was supported by an institutional training grant from the National Institute of Child Health and Human Development [T32-GM00754635].

This article has been presented in abstract form at the American Thoracic Society, May 21, 2014, San Diego, CA; the Respiratory Disease Young Investigators’ Forum, October 18, 2014, Washington, DC; and the California Thoracic Society, January 30, 2015, Carmel, CA.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;147(6):1591-1598. doi:10.1378/chest.14-2689
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Published online

BACKGROUND:  Obesity is associated with poor asthma control, increased asthma morbidity, and decreased response to inhaled corticosteroids. We hypothesized that obesity would be associated with decreased bronchodilator responsiveness in children and adolescents with asthma. In addition, we hypothesized that subjects who were obese and unresponsive to bronchodilator would have worse asthma control and would require more asthma controller medications.

METHODS:  In the Study of African Americans, Asthma, Genes, and Environments (SAGE II) and the Genes-environments and Admixture in Latino Americans (GALA II) study, two identical, parallel, case-control studies of asthma, we examined the association between obesity and bronchodilator response in 2,963 black and Latino subjects enrolled from 2008 to 2013 using multivariable logistic regression. Using bronchodilator responsiveness, we compared asthma symptoms, controller medication usage, and asthma exacerbations between nonobese (< 95th% BMI) and obese (≥ 95th% BMI) subjects.

RESULTS:  The odds of being bronchodilator unresponsive were 24% (OR, 1.24; 95% CI, 1.03-1.49) higher among obese children and adolescents compared with their not obese counterparts after adjustment for age, race/ethnicity, sex, recruitment site, baseline lung function (FEV1/FVC), and controller medication. Bronchodilator-unresponsive obese subjects were more likely to report wheezing (OR, 1.38; 95% CI, 1.13-1.70), being awakened at night (OR, 1.34; 95% CI, 1.09-1.65), using leukotriene receptor inhibitors (OR, 1.33; 95% CI, 1.05-1.70), and using inhaled corticosteroid with long-acting β2-agonist (OR, 1.37; 95% CI, 1.05-1.78) than were their nonobese counterpart. These associations were not seen in the bronchodilator-responsive group.

CONCLUSIONS:  Obesity is associated with bronchodilator unresponsiveness among black and Latino children and adolescents with asthma. The findings on obesity and bronchodilator unresponsiveness represent a unique opportunity to identify factors affecting asthma control in blacks and Latinos.


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