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One Quarter of Obesity-Related New Pediatric Asthma Cases



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About 23% to 27% of new asthma cases in children are caused by obesity directly, new research indicates.

"In the absence of hypertension and obesity, 10% of all the cases of pediatric asthma in the United States could be avoided," write Jason E. Lang, MD, MPH, Allergy and Immunology Divisions and Dwl Medicine at the University of Medicine School Duke and Double Children's Hospital and Health Center in Durham, North Carolina, and colleagues.

The findings were published online today Paediatrics.

Obesity has previously linked to new cases of asthma in adults, and researchers estimate that obesity causes about 250,000 new adult cases a year. The current study is the first to measure the causes and risk across a large, diverse national pediatric population.

Lang and colleagues used the PEDSnet clinical data research network to compare cases of asthma in children overweight and / or obese with children with a healthy weight between 2 and 17 years of age. Data from 507,496 children and 19,581,972 events were analyzed between January 2009 and December 2015. The researchers were the same as individual children who were classified overweight or obese in 1: 1 ratio with children whose weight in a healthy range. Children were also matched for demographic features and insurance status. The average observation period was 4 years.

Frequency is defined as at least two across with a diagnosis of asthma and at least one asthma controller prescription.

Overall, the risk adapted for an asthma event was higher among children overweight (relative risk [RR], 1.17; 95% confidence interval [CI], 1.10 – 1.25) and obese children (RR, 1.26; 95% CI, 1.18 – 1.34). The risk adapted for asthma-confirmed asthma was also higher among obese children (RR, 1.29; 95% CI, 1.16 – 1.42).

Few Preventative Measures for Asthma

The findings are important because there are not many preventive measures to reduce childhood asthma, the authors' goal.

This data suggests reducing obesity in children "significantly reduces the public health burden," they write.

In accompaniment editorial , Deepa Rastogi, MBBS, MS, of the Children's Hospital in Montefiore, the Albert Einstein College of Medicine in the Bronx, New York, says that the numbers show another reason that these findings are so important. She explains that the prevalence of pediatric asthma has remained around 10% for many years despite developments in early diagnosis, controlling and mitigating environmental factors. At the same time, obesity rates are almost 20% and arise among some groups, and these new data show how this could increase pediatric asthma rates.

"[W]He looks at a ~ 5% increase in childhood asthma due to obesity, suggesting that asthma caused by obesity over time becomes a great form of childhood asthma, "he said.

Rastogi indicates the strength of the study is that the database, PEDSnet, contains data from eight main American pediatric health systems, allowing extensively to look at races, ethnicity, and different definitions of asthma.

Coupling children for demographic features and insurance status separates the possibility of hitting those variables, she says.

Given the findings, Rastogi suggests that clinicians measure the circumference of the waist and measure metabolic abnormalities when evaluating pediatric patients with obesity in order to better identify those at risk of developing lung complications.

"As normative values ​​exist for the circumference of the waist and for the distribution of metabolic abnormalities in children, those with evidence of [one or more] of these complications related to obesity should be the ones that are screened for asthma, "he said.

Further research, he said, should investigate why some obese children develop asthma and some do not, and differentiate children who become obese as a result asthma from asthma development as a result o obesity. This information, which said Rastogi, will help to develop new targeted therapies.

2 to 17 year olds were eligible to be included in the study if they had a body mass index that had age and sex adjustment in at least 85 percentages and without any diagnosis of asthma or wheat diagnosis during the initial visit during or prior to the period of study.

The study excluded children using asthma medications without formal diagnosis and those diagnosed with asthma within 18 months of the initial visit. Children were also exempt if they had documented cystic fibrosis, ciliary dyskinesia, childhood cancer, inflammation bowel disease, or bronchopulmonary dysplasia.

The study was funded by the Patient Focus Outcomes Research Institute and institutional development funds from the Nemours Children's Hospital and the Nemours Child Health System.

One author reports on advisory boards for Merck, Sanofi Pasteur, and Pfizer, and works as a consultant for Pfizer, but does not receive money from these entities.

The authors of another study and Rastogi have not revealed any relevant financial relatives.

Paediatrics. Published online November 26, 2018. Full text, Editorial

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