The effect of excess weight on asthma control among children

Background: Asthma is the most common chronic pediatric illness in developed countries with nearly 10 million affected in North America. Patients affected with the disease can function without compromising their quality of life if the appropriate clinical treatment guidelines for optimal asthma management are used. However, 50% of patients fail to abide by the guidelines and in turn experience poor asthma control. Due to the physiological differences in overweight children with asthma, the effect of obesity on poor asthma control can lead to more serious outcomes. As a result of the documented physiological differences and pharmacokinetics, overweight children with asthma may experience poor asthma control. Objective: The objective of the study is to determine to what extent weight affects asthma control among children in Quebec. Methods: A retrospective historical cohort study was conducted from an existing Régie De L’Assurance Maladie du Québec (RAMQ) dataset generated from a population-based follow-up study. The sampling frame consisted of children aged 2-12 presented at the Montreal Children’s Hospital Asthma Center (Canada, Quebec) between January 1st 2002 and December 31st 2007, a final sample of 817 was obtained. Data was collected from information documented in the RAMQ, the Quebec Provincial Drug Plan and the MED-ECHO database. Study participants were classified under normal weight (BMI < 85th percentile) and excess weight (BMI 85th > percentile). Data Analysis: Basic descriptive statistics were produced to describe the study sample and test relationships of key variables with weight and asthma control. Univariate and multivariate logistic regression analyses were performed to test the hypothesis that excess weight children with asthma experience poor asthma control in comparison to normal weight children as indicated by predictors. The primary indicator was measured as the use of short-acting b2-agonists (SABA) defined by North American and International standards. The secondary outcome was measured as the rate of asthma related acute care visits, hospital admission and use of oral corticosteroids (OCS) during the one-year follow up. Results: Excess weight was found not to be associated with the use of b2 agonists and by extension, asthma control (OR=1.15, 95% CI 0.83-1.58). In addition, excess weight was not associated with acute care visits, hospital admission or the use of OCS.Conclusion: An association between excess weight and the use of SABA and by extension, asthma control was not observed, these results are congruent with some published literature. However, we speculate that with a larger sample size we would be able to make more accurate inferences in the extent to which excess weight affect the use of ß2-agonists.

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