Obesity and bronchodilator response in black and Hispanic children and adolescents with asthma.
BACKGROUND
Obesity is associated with poor asthma control, increased asthma morbidity, and decreased response to inhaled corticosteroids. We hypothesized that obesity would be associated with decreased bronchodilator responsiveness in children and adolescents with asthma. In addition, we hypothesized that subjects who were obese and unresponsive to bronchodilator would have worse asthma control and would require more asthma controller medications.


METHODS
In the Study of African Americans, Asthma, Genes, and Environments (SAGE II) and the Genes-environments and Admixture in Latino Americans (GALA II) study, two identical, parallel, case-control studies of asthma, we examined the association between obesity and bronchodilator response in 2,963 black and Latino subjects enrolled from 2008 to 2013 using multivariable logistic regression. Using bronchodilator responsiveness, we compared asthma symptoms, controller medication usage, and asthma exacerbations between nonobese (< 95th% BMI) and obese (≥ 95th% BMI) subjects.


RESULTS
The odds of being bronchodilator unresponsive were 24% (OR, 1.24; 95% CI, 1.03-1.49) higher among obese children and adolescents compared with their not obese counterparts after adjustment for age, race/ethnicity, sex, recruitment site, baseline lung function (FEV1/FVC), and controller medication. Bronchodilator-unresponsive obese subjects were more likely to report wheezing (OR, 1.38; 95% CI, 1.13-1.70), being awakened at night (OR, 1.34; 95% CI, 1.09-1.65), using leukotriene receptor inhibitors (OR, 1.33; 95% CI, 1.05-1.70), and using inhaled corticosteroid with long-acting β2-agonist (OR, 1.37; 95% CI, 1.05-1.78) than were their nonobese counterpart. These associations were not seen in the bronchodilator-responsive group.


CONCLUSIONS
Obesity is associated with bronchodilator unresponsiveness among black and Latino children and adolescents with asthma. The findings on obesity and bronchodilator unresponsiveness represent a unique opportunity to identify factors affecting asthma control in blacks and Latinos.
Department of Pediatrics, University of California, San Francisco, CA. Electronic address: DrMeghanMcGarry@gmail.com.
Meghan E
ME
McGarry
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA.
Elizabeth
E
Castellanos
Department of Medicine, University of California, San Francisco, CA.
Neeta
N
Thakur
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA.
Sam S
SS
Oh
Department of Medicine, University of California, San Francisco, CA.
Celeste
C
Eng
Children's Hospital and Research Center Oakland, Oakland, CA.
Adam
A
Davis
Children's Hospital and Research Center Oakland, Oakland, CA.
Kelley
K
Meade
Bay Area Pediatrics, Oakland, CA.
Michael A
MA
LeNoir
Department of Allergy-Immunology, Northwestern University, Chicago, IL.
Pedro C
PC
Avila
Department of Pediatrics, Section of Pulmonology, Baylor College of Medicine and Texas Children's Hospital, Houston, TX.
Harold J
HJ
Farber
Pediatric Pulmonary Division, Jacobi Medical Center, Bronx, NY.
Denise
D
Serebrisky
Department of Allergy and Immunology, Kaiser Permanente-Vallejo Medical Center, Vallejo, CA.
Emerita
E
Brigino-Buenaventura
Veterans Caribbean Health Care System, San Juan, Puerto Rico.
William
W
Rodriguez-Cintron
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, IL.
Rajesh
R
Kumar
San Francisco General Hospital, San Francisco, CA.
Kirsten
K
Bibbins-Domingo
Department of Pediatrics, University of California, San Francisco, CA.
Shannon M
SM
Thyne
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
Saunak
S
Sen
Centro de Neumología Pediátrica, San Juan, Puerto Rico.
Jose R
JR
Rodriguez-Santana
Department of Health Sciences, Lehman College, City University of New York, Bronx, NY.
Luisa N
LN
Borrell
Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, CA; Department of Medicine, University of California, San Francisco, CA.
Esteban G
EG
Burchard
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000420:Albuterol / Q000008:administration & dosage / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology* / Q000503:physiopathology; D044383:Black People; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D016022:Case-Control Studies; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D020024:Leukotriene Antagonists / Q000008:administration & dosage / Q000627:therapeutic use; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000150:complications* / Q000503:physiopathology; D012189:Retrospective Studies; D016896:Treatment Outcome; D001741:Black or African American
D000305:Adrenal Cortex Hormones; D001993:Bronchodilator Agents; D020024:Leukotriene Antagonists; D000420:Albuterol