Overweight Children Misinterpret Asthma Symptoms, Might Overuse Medication

A recent study published online in the Journal of Allergy and Clinical Immunology (JACI), the official scientific journal of the American Association of Allergy, Asthma and Immunology, shows that obese children with asthma may use unnecessary rescue medications due to mistaken symptoms of breathlessness for loss of asthma control.

“Obese children with asthma need to develop a greater understanding of the distinct feeling of breathlessness in order to avoid not just unnecessary medication use, but also the anxiety, reduced quality of life and health care utilization that come along with this misunderstood symptom,” said physician Jason Lang, MD, MPH, researcher in the Division of Pulmonary Medicine at Nemours Children’s Hospital in Orlando, FL in a press release. “Alleviating this overuse of rescue medications could likely also lessen other symptoms obese children with asthma are impacted by, including most notably acid reflux.”

58 obese/overweight children with the disease (BMI ≥ 85th percentile) and lean counterparts  (BMI 20-65th percentile) participated in 3 clinical visits, in which Lang’s research team reviewed some topics such as lung function, treatment usage, symptom patterns, healthcare utilization, quality of life, and caregiver perception of asthma-related quality of life.

Both groups of children exhibited similar lung function and controller therapy; nevertheless, obese children with asthma experienced symptoms differently compared to lean children. Obese children noted symptoms of shortness of breath instead of cough and they used three times more self-medication with the short-acting Beta-agonist (SABA). Obese children also had lower asthma-related quality of life and more gastrointestinal symptoms reported.

Much of the problematic nature of asthma among obese children with allergic and early-onset asthma may reside in part from heightened airflow perception and gastroesophageal reflux disease (GERD) symptoms that conduct to breathlessness sensation, according to the researchers. Additionally, high usage of SABA medication was previously proven to reduce lower esophageal sphincter tone, extending a cycle of GERD, chest symptoms and even more SABA use.

These results suggest that physicians that treat overweight/obese asthmatic children should consider weight loss or other alternative strategies such as sports, as previously suggested by Dr. Perdita Permaul, to improve GERD and other asthma-related symptoms and reduce medication utilization.

“This research helps define how overweight and obesity affect the patterns and severity of asthma symptoms in children,” explained Lang.

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