Obesity a Risk Factor for Rehospitalization in Youth with Asthma

Children with asthma who are obese are more likely to be admitted to the hospital than normal weight children with asthma, according to a new study.

Young children hospitalized for asthma who were obese were also more likely to be re-admitted to the hospital within 30 days and to stay at the hospital for a longer period of time.

The researchers published their results October 18, 2017 in Pediatric Immunology and Allergy.
Obese children are at increased risk for developing asthma. Commonly cited potential etiologies include

• Airway smooth muscle dysfunction from thoracic restriction
• Obesity-related circulating inflammation priming the lung
• Obesity-related comorbidities mediating asthma symptom development

Other possible causes include a Western diet that might lead to both obesity and asthma; reductions in physical activity; and genetic alterations that increase the propensity to both obesity and asthma together.

Also, obesity affects common characteristics of asthma, including airway inflammation, lung function, risks of exacerbation, atopy, and response to treatment. Obese children with asthma appear to have greater airflow obstruction and a mildly diminished response to inhaled corticosteroids.

Using hospital discharge records of inpatients aged three to eight years with a diagnosis of asthma from a national inpatient database in Japan, researchers identified 38679 patients, including 3177 patients who were underweight, 28904 patients of normal weight, 3334 patients who were overweight, and 3264 obese patients.
Then they compared 30-day hospital readmission, need for intensive care, average total hospital costs and length of hospital stay among all patients.

The obese group showed a significantly higher 30-day readmission (26%) and longer length of stay than the normal weight group. No significant difference was observed between the four weight groups regarding the need for intensive care and total hospitalization costs.

Potential risk factors for asthma include age, race and ethnicity, socioeconomic status, medication adherence, access to health care, and a history of sinusitis, the researchers stated. They also noted that a 2013 review of 35 studies found that gender plays a role, with obese girls more likely to have asthma diagnoses than obese boys.
This is consistent with several studies among adult asthma patients in which obese women were found to be more likely to have asthma or worse asthma control. Hormones or changing body composition may be one of the factors implicated in the increase of asthma among women.

In general, obese children with asthma should receive the same guidelines-based management as asthmatic children of normal weight. The results suggest that clinicians should consider offering interventions that encourage daily physical activity, weight loss, eating a healthy diet, and monitoring of obesity to better manage obese children with difficult-to-control asthma.