title: Poor asthma control in obese children may be overestimated because of enhanced perception of dyspnea.
abstract: BACKGROUND
  Although studies in adults have shown a non-TH2 obese asthma phenotype, whether a similar phenotype exists in children is unclear.
  
  
  OBJECTIVE
  We hypothesized that asthmatic children with obesity, defined as a body mass index above the 95th percentile for age and sex, would have poorer asthma control as well as decreased quality of life, increased health care utilization, and decreased pulmonary function measures as a function of increased TH1 versus TH2 polarization.
  
  
  METHODS
  This study involved a post hoc analysis of cross sectional data from 269 children 6 to 17 years of age enrolled in the National Heart, Lung, and Blood Institute Severe Asthma Research Program. Children answered questionnaires and underwent spirometry, plethysmography, exhaled nitric oxide determination, and venipuncture for TH1/TH2 cytokine determination. Asthma control was defined according to national asthma treatment guidelines that are based on prespecified thresholds for lung function and symptom frequency.
  
  
  RESULTS
  Fifty-eight children (22%) were overweight and 67(25%) were obese. Obese children did not have poorer asthma control but were more likely to report nonspecific symptoms such as dyspnea and nocturnal awakenings. Obese children did have decreased asthma-related quality of life and increased health care utilization, but this was not associated with airflow limitation. Instead, obese children had decreased functional residual capacity. A unique pattern of TH1 or TH2 polarization was not observed.
  
  
  CONCLUSIONS
  Poor asthma control in obese children with asthma may be overestimated because of enhanced perception of nonspecific symptoms such as dyspnea that results from altered mechanical properties of the chest wall. Careful assessment of physiologic as well as symptom-based measures is needed in the evaluation of obese children with respiratory symptoms.
authors: Pravin K
authors: PK
authors: Sah
authors: W
authors: W
authors: Gerald Teague
authors: Karen A
authors: KA
authors: Demuth
authors: Denise R
authors: DR
authors: Whitlock
authors: Sheena D
authors: SD
authors: Brown
authors: Anne M
authors: AM
authors: Fitzpatrick
mesh_terms: D000015:Abnormalities, Multiple; D000293:Adolescent; D001249:Asthma / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D002648:Child; D019465:Craniofacial Abnormalities; D003430:Cross-Sectional Studies; D016207:Cytokines / Q000097:blood; D004417:Dyspnea / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D005260:Female; D005652:Functional Residual Capacity / Q000502:physiology; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D007249:Inflammation / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D008168:Lung / Q000503:physiopathology; D008297:Male; D009569:Nitric Oxide / Q000378:metabolism; D009765:Obesity / Q000150:complications / Q000378:metabolism / Q000503:physiopathology*; D050177:Overweight / Q000150:complications / Q000378:metabolism / Q000503:physiopathology; D010859:Pigmentation Disorders; D010991:Plethysmography / Q000379:methods / Q000706:statistics & numerical data; D012129:Respiratory Function Tests / Q000379:methods / Q000706:statistics & numerical data; D013147:Spirometry / Q000379:methods; D011795:Surveys and Questionnaires
chemical_list: D016207:Cytokines; D009569:Nitric Oxide
references: Eur Respir J. 2006 Mar;27(3):495-503
references: 16507848
references: CMAJ. 2008 Nov 18;179(11):1121-31
references: 19015563
references: Pediatrics. 2006 Dec;118(6):2443-9
references: 17142530
references: JAMA. 2012 Feb 1;307(5):483-90
references: 22253364
references: Chest. 2012 Apr;141(4):895-905
references: 21980061
references: Am J Respir Crit Care Med. 2008 Oct 1;178(7):682-7
references: 18635892
references: Chest. 2010 Jun;137(6):1316-23
references: 20154078
references: J Allergy Clin Immunol. 2011 Jun;127(6):1486-93.e2
references: 21624618
references: Am J Respir Crit Care Med. 2012 Feb 15;185(4):356-62
references: 22095547
references: Ann Allergy Asthma Immunol. 2011 Jan;106(1):30-5
references: 21195942
references: J Allergy Clin Immunol. 2011 Nov;128(5):964-9
references: 21820711
references: J Allergy Clin Immunol. 2011 Sep;128(3):508-15.e1-2
references: 21782230
references: Chest. 2012 Mar;141(3):616-624
references: 21868466
references: Am J Respir Crit Care Med. 2010 Feb 15;181(4):315-23
references: 19892860
references: J Allergy Clin Immunol. 2010 Mar;125(3):584-92
references: 20226295
references: Biol Psychol. 2010 Apr;84(1):135-41
references: 19941934
references: PLoS One. 2012;7(5):e36631
references: 22606276
references: Curr Opin Allergy Clin Immunol. 2012 Apr;12(2):186-92
references: 22391755
references: Am J Respir Crit Care Med. 2008 Aug 1;178(3):218-224
references: 18480428
references: J Appl Physiol (1985). 2010 Mar;108(3):754-9
references: 19926826
references: Nat Med. 2012 May 04;18(5):716-25
references: 22561835
references: NCHS Data Brief. 2012 May;(94):1-8
references: 22617340
references: J Allergy Clin Immunol. 2007 Mar;119(3):591-6
references: 17208288
references: Arch Intern Med. 2002 Jul 8;162(13):1477-81
references: 12090884
references: J Appl Physiol (1985). 2005 Feb;98(2):512-7
references: 15475605
references: J Allergy Clin Immunol. 2009 Jun;123(6):1328-34.e1
references: 19501235
references: Eur Respir J. 2005 Aug;26(2):319-38
references: 16055882
references: Eur Respir J. 2011 Sep;38(3):594-602
references: 21310876
references: J Allergy Clin Immunol. 2011 Sep;128(3):485-94
references: 21798579
references: J Allergy Clin Immunol. 2007 Nov;120(5 Suppl):S94-138
references: 17983880
references: Eur Respir J. 2012 May;39(5):1120-6
references: 21885396
references: J Allergy Clin Immunol. 2011 Feb;127(2):382-389.e1-13
references: 21195471
references: Pediatr Pulmonol. 2012 Nov;47(11):1061-9
references: 22467360
references: Pediatr Allergy Immunol Pulmonol. 2010 Jun;23(2):131-138
references: 21761006
references: Chest. 2011 Dec;140(6):1524-1533
references: 21799027
references: Int J Obes (Lond). 2008 Mar;32(3):502-9
references: 17955030
references: Eur J Pediatr. 2001 May;160(5):300-6
references: 11388599
references: J Appl Physiol (1985). 2010 Mar;108(3):729-34
references: 19875708
references: Am Rev Respir Dis. 1993 Apr;147(4):832-8
references: 8466117
references: Am J Respir Crit Care Med. 1999 Jan;159(1):179-87
references: 9872837
references: Proc Am Thorac Soc. 2010 Sep;7(5):325-35
references: 20844291
references: J Allergy Clin Immunol. 2011 Mar;127(3):741-9
references: 21377042
references: Eur Respir J. 2008 Jul;32(1):85-91
references: 18353855