Overweight in Preschool Children Associated With Worse Asthma

Asthma, a leading cause of emergency department visits and hospitalizations among American preschoolers, may be worse in children aged 2 to 5 who are overweight or obese.

A new study, published in the Journal of Allergy and Clinical Immunology, sought to describe the relationship between weight and asthma severity and response to inhaled corticosteroid therapy in preschool children, and found that, among children not treated with a daily controller, overweight children had more asthma symptom days and exacerbations than did children who had normal weight.

In the study of 736 preschool children with asthma, overweight status affected 33% (n = 244) at baseline. The children in the overweight group had 63% higher odds of having been hospitalized in the 12 months prior to enrollment (odds ratio [OR], 1.63; 95% CI, 1.07-2.48). However, weight did not seem to reduce the efficacy of corticosteroid inhalers in this patient population; when patients (n = 485) were randomized to an inhaled corticosteroid intervention, the researchers found no evidence that overweight status affected annualized asthma symptom days.

"The impact of overweight and obesity on asthma has not been studied in the youngest asthma patients, and this finding is the opposite of what has been seen in older kids and adults who are overweight," lead researcher Jason Lang, MD, MPH, said in a statement. “Reports in older children and adults with asthma who are overweight have shown a poor response to inhaled corticosteroids to manage their asthma. This study suggests either pathways of inflammation are a bit different in preschool-aged patients, or that it takes years for obesity to reduce the effectiveness of steroid inhalers."

The researchers concluded that, while high body mass index in early life does appear to worsen asthma in preschool children who are not being treated with controller therapy, overweight status is not clearly associated with a reduced response to inhaled corticosteroids.

“Weight does not hamper the effectiveness of inhaled steroids in preschoolers,” said Lang, “but this study provides clear evidence that maintaining a healthy weight in preschoolers may be an effective strategy for controlling asthma."