title: Overweight children report qualitatively distinct asthma symptoms: analysis of validated symptom measures.
abstract: BACKGROUND
  Past studies of asthma in overweight/obese children have been inconsistent. The reason overweight/obese children commonly report worse asthma control remains unclear.
  
  
  OBJECTIVE
  To determine qualitative differences in symptoms between lean and overweight/obese children with early-onset, atopic asthma.
  
  
  METHODS
  We conducted a cross-sectional analytic study of lean (20% to 65% body mass index) and overweight/obese (≥85% body mass index) 10- to 17-year-old children with persistent, early-onset asthma. Participants completed 2 to 3 visits to provide a complete history, qualitative and quantitative asthma symptom characterization, and lung function testing. We determined associations between weight status and symptoms using multivariable linear and logistic regression methods.
  
  
  RESULTS
  Overweight/obese and lean asthmatic children displayed similar lung function. Despite lower fraction of exhaled nitric oxide (30.0 vs 62.6 ppb; P = .037) and reduced methacholine responsiveness (PC20FEV1 1.87 vs 0.45 mg/mL; P < .012), overweight/obese children reported more than thrice frequent rescue treatments (3.7 vs 1.1 treatments/wk; P = .0002) than did lean children. Weight status affected the child's primary symptom reported with loss of asthma control (Fisher exact test; P = .003); overweight/obese children more often reported shortness of breath (odds ratio = 11.8; 95% CI, 1.41-98.7) and less often reported cough (odds ratio = 0.26; 95% CI, 0.08-0.82). Gastroesophageal reflux scores were higher in overweight/obese children (9.6 vs 23.2; P = .003) and appear to mediate overweight/obesity-related asthma symptoms.
  
  
  CONCLUSIONS
  Overweight/obese children with early-onset asthma display poorer asthma control and a distinct pattern of symptoms. Greater shortness of breath and β-agonist use appears to be partially mediated via esophageal reflux symptoms. Overweight children with asthma may falsely attribute exertional dyspnea and esophageal reflux to asthma, leading to excess rescue medication use.
authors.affiliation: Division of Pulmonary & Sleep Medicine, Nemours Children's Hospital, Orlando, Fla. Electronic address: jason.lang@nemours.org.
authors.forename: Jason E
authors.initials: JE
authors.lastname: Lang
authors.affiliation: Center for Pediatric Research, Alfred I. DuPont Hospital of Children, Wilmington, Del.
authors.forename: Md Jobayer
authors.initials: MJ
authors.lastname: Hossain
authors.affiliation: Center for Pharmacogenomics & Translational Research, Nemours Children's Clinic, Jacksonville, Fla.
authors.forename: John J
authors.initials: JJ
authors.lastname: Lima
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications* / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D015992:Body Mass Index; D001835:Body Weight; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D009765:Obesity / Q000150:complications; D050177:Overweight / Q000150:complications*; D010342:Patient Acceptance of Health Care; D036301:Qualitative Research; D012129:Respiratory Function Tests; D012307:Risk Factors; D063189:Symptom Assessment
keywords: Asthma; breathlessness; children; dyspnea; esophageal reflux; obesity; overweight; shortness of breath