Asthma and lower airway diseaseDecreased response to inhaled steroids in overweight and obese asthmatic children
Section snippets
Study population
The Childhood Asthma Management Program (CAMP) study is a randomized clinical trial that enrolled 1,041 children with asthma between 1993 and 1995. A detailed description of the trial has been previously published.17 Inclusion criteria were age 5 to 12 years, a history of asthma for at least 6 months in the previous year, mild-to-moderate asthma severity, and airway responsiveness to 12.5 mg/mL or less of methacholine. Subjects were randomly assigned to one of 3 inhaled treatment arms (200 μg
Results
Baseline characteristics of the study population are presented in Table I. As expected from randomization, there were no differences in most subjects’ characteristics among treatment arms at baseline within each BMI group (overweight/obese vs nonoverweight). However, serum vitamin D levels were slightly higher in children receiving inhaled budesonide than in those receiving inhaled placebo or nedocromil regardless of BMI group. The mean age of the 1,041 participating children was 8.9 years,
Discussion
To our knowledge, this is the first report of modification of the effect of inhaled corticosteroids on pediatric asthma control by overweight/obesity status. Among children in a large multicenter clinical trial, nonoverweight children had more consistent and significant effects of inhaled budesonide on measures of lung function and asthma morbidity and severity than overweight/obese children.
FEV1 and FEV1/FVC ratio are widely used in clinical practice and constitute one of the components of the
References (51)
- et al.
Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries
Lancet
(2009) - et al.
Obesity, inflammation, and asthma severity in childhood: data from the National Health and Nutrition Examination Survey 2001-2004
Ann Allergy Asthma Immunol
(2009) - et al.
TNF-alpha induces the late-phase airway hyperresponsiveness and airway inflammation through cytosolic phospholipase A(2) activation
J Allergy Clin Immunol
(2005) - et al.
PRKCA: a positional candidate gene for body mass index and asthma
Am J Hum Genet
(2009) - et al.
Glucocorticoid resistance in asthma is associated with elevated in vivo expression of the glucocorticoid receptor beta-isoform
J Allergy Clin Immunol
(2000) - et al.
Effect of leptin on allergic airway responses in mice
J Allergy Clin Immunol
(2005) - et al.
Adiponectin attenuates allergen-induced airway inflammation and hyperresponsiveness in mice
J Allergy Clin Immunol
(2006) - et al.
Asthma control, adiposity, and adipokines among inner-city adolescents
J Allergy Clin Immunol
(2010) - et al.
Patients with asthma who do not fill their inhaled corticosteroids: a study of primary nonadherence
J Allergy Clin Immunol
(2007) - et al.
Excessive body weight is associated with additional loss of quality of life in children with asthma
J Allergy Clin Immunol
(2007)
Worldwide trends in childhood overweight and obesity
Int J Pediatr Obes
Systematic review of worldwide variations of the prevalence of wheezing symptoms in children
Environ Health
The state of childhood asthma, United States, 1980-2005
Adv Data
Prevalence and trends in overweight among US children and adolescents, 1999-2000
JAMA
Prevalence of overweight and obesity in the United States, 1999-2004
JAMA
A meta-analysis of the effect of high weight on asthma
Arch Dis Child
Increasing body mass index from age 5 to 14 years predicts asthma among adolescents: evidence from a birth cohort study
Int J Obes (Lond)
The asthma-obesity link in childhood: open questions, complex evidence, a few answers only
Clin Exp Allergy
Higher adiposity in infancy associated with recurrent wheeze in a prospective cohort of children
J Allergy Clin Immunol
Percent body fat, skinfold thickness or body mass index for defining obesity or overweight, as a risk factor for asthma in schoolchildren: which one to use in epidemiological studies?
Matern Child Nutr
Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP)
Thorax
Obesity increases the risk of incident asthma among adults
Eur Respir J
Obesity, insulin resistance and the prevalence of atopy and asthma in US adults
Allergy
Obesity and asthma
Am J Respir Crit Care Med
The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group
Control Clin Trials
Cited by (265)
Management of the pediatric patient with asthma and obesity
2024, Annals of Allergy, Asthma and ImmunologyAdding oscillometry to spirometry in guidelines better identifies uncontrolled asthma, future exacerbations, and potential targeted therapy
2024, Annals of Allergy, Asthma and ImmunologyImpact of obesity in asthma: Possible future therapies
2024, Allergology InternationalPlatycoside E alleviates allergic airway inflammation in obesity-related asthma mouse model
2023, Molecular ImmunologyContributions of the early-life microbiome to childhood atopy and asthma development
2023, Seminars in ImmunologyHigher Body Mass Index Is Associated With Decreased Treatment Response to Topical Steroids in Eosinophilic Esophagitis
2023, Clinical Gastroenterology and Hepatology
The Childhood Asthma Management Program (CAMP) trial and CAMP Continuation Study were supported by contracts NO1-HR-16044, 16045, 16046, 16047, 16048, 16049, 16050, 16051, and 16052 with the National Heart, Lung, and Blood Institute and General Clinical Research Center grants M01RR00051, M01RR0099718-24, M01RR02719-14, and RR00036 from the National Center for Research Resources.
Disclosure of potential conflict of interest: A. Fuhlbrigge is a consultant for Genentech, Novartis, and the Lovelace Respiratory Research Institute and serves on respiratory specialist advisory panels for Sunovion and Merck. The rest of the authors have declared that they have no conflict of interest.