title: Obesity and Airway Dysanapsis in Children with and without Asthma.
abstract: BACKGROUND
  For unclear reasons, obese children with asthma have higher morbidity and reduced response to inhaled corticosteroids.
  
  
  OBJECTIVE
  To assess whether childhood obesity is associated with airway dysanapsis (an incongruence between the growth of the lungs and the airways) and whether dysanapsis is associated with asthma morbidity.
  
  
  METHODS
  We examined the relationship between obesity and dysanapsis in six cohorts of children with and without asthma, as well as the relationship between dysanapsis and clinical outcomes in children with asthma. Adjusted odds ratios (ORs) were calculated for each cohort and in a combined analysis of all cohorts; longitudinal analyses were also performed for cohorts with available data. Hazard ratios (HRs) for clinical outcomes were calculated for children with asthma in the Childhood Asthma Management Program.
  
  
  RESULTS
  Being overweight or obese was associated with dysanapsis in both the cross-sectional (OR, 1.95; 95% confidence interval [CI], 1.62-2.35 [for overweight/obese compared with normal weight children]) and the longitudinal (OR, 4.31; 95% CI, 2.99-6.22 [for children who were overweight/obese at all visits compared with normal weight children]) analyses. Dysanapsis was associated with greater lung volumes (FVC, vital capacity, and total lung capacity) and lesser flows (FEV1and forced expiratory flow, midexpiratory phase), and with indicators of ventilation inhomogeneity and anisotropic lung and airway growth. Among overweight/obese children with asthma, dysanapsis was associated with severe disease exacerbations (HR, 1.95; 95% CI, 1.38-2.75) and use of systemic steroids (HR, 3.22; 95% CI, 2.02-5.14).
  
  
  CONCLUSIONS
  Obesity is associated with airway dysanapsis in children. Dysanapsis is associated with increased morbidity among obese children with asthma and may partly explain their reduced response to inhaled corticosteroids.
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Erick
authors.identifier: http://orcid.org/0000-0001-6497-9885
authors.initials: E
authors.lastname: Forno
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Weiner
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: James
authors.initials: J
authors.lastname: Mullen
authors.affiliation: 2 Division of Pulmonary Diseases, Boston Children's Hospital, Boston, Massachusetts.
authors.forename: Gregory
authors.initials: G
authors.lastname: Sawicki
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Kurland
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Yueh Ying
authors.initials: YY
authors.lastname: Han
authors.affiliation: 3 Department of Pediatrics, University of Connecticut Health Center, Connecticut Children's Medical Center, Farmington, Connecticut.
authors.forename: Michelle M
authors.initials: MM
authors.lastname: Cloutier
authors.affiliation: 4 Behavioral Sciences Research Institute, University of Puerto Rico, San Juan, Puerto Rico.
authors.forename: Glorisa
authors.initials: G
authors.lastname: Canino
authors.affiliation: 5 Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; and.
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
authors.affiliation: 5 Channing Division of Network Medicine, Department of Medicine, Harvard Medical School, Boston, Massachusetts; and.|6 Brigham and Women's Hospital, Boston, Massachusetts.
authors.forename: Augusto A
authors.initials: AA
authors.lastname: Litonjua
authors.affiliation: 1 Division of Pulmonary Medicine, Allergy, and Immunology, Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, University of Pittsburgh, Pittsburgh, Pennsylvania.
authors.forename: Juan C
authors.initials: JC
authors.lastname: Celedón
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use*; D000403:Airway Resistance; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D016022:Case-Control Studies; D002648:Child; D015897:Comorbidity; D004351:Drug Resistance; D005260:Female; D005540:Forced Expiratory Flow Rates; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D015337:Multicenter Studies as Topic; D009765:Obesity / Q000453:epidemiology / Q000503:physiopathology*; D016016:Proportional Hazards Models; D014797:Vital Capacity; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: airway dysanapsis; childhood asthma; childhood obesity; pulmonary function