Bronchial Asthma and Obesities in Children – The Connection between the “Social Epidemics”

Background: Bronchial asthma (BA) and obesities show dramatically risen incidence over the years. In USA for a period of 16 years (1980-1996) BA incidence rose from 7,4% to 9.3%. In the meantime for 30 years the number of obese children had tripled (from 7% to 18%) and the one of obese adolescents had quadrupled (from 5% to 21%). There is still a debate whether there is a connection between both diseases. Inhaled corticosteroids (ICS) are the recommended therapy for BA in children. Obesity is considered a risk factor for asthma in the same way as stigmatizing ICS for increased weight.

Methods: We evaluated the medical data and weight of 200 children (aged 5 to 17 years) admitted for asthma attack regarding the asthma severity, the natural history of asthma and inhaled corticosteroid (ICS) treatment period. As a control group we used age and sex matched children without history of asthma or other allergic diseases.

Results: There were not any significant correlations between weight and the ICS treatment, family history or atopy status (p>0.05). When we stratified the asthma children according the ICS use, surprisingly those who are not on ICS therapy have a tendency to be heavier than children on ICS or controls (p=0.06 BA on ICS vs BA without ICS; p=0,07 BA without ICS vs controls). Stratifying according the asthma control - those with good control don’t show difference from the control group, while cases with poor control are with tendency to be overweight vs controls (p=0.054). Stratifying according the weight we found worse control in both overweight and underweight children compared to those with normal weight.

Conclusion: We assume that long-term ICS therapy is not that determining for weight status in BA patients. Children, with good control, optimal dose ICS with proper inhalation technique, following regular exercise regimen and proper diet can maintain optimal weight, which in turn supports better control.