Preschool children who are overweight or obese are likely to have more asthma attacks and disease symptoms than their normal-weight peers, but these children still respond well to treatment with inhaled corticosteroids, a study finds.
Excessive weight or obesity is known to be associated with worse asthma and poor inhaled corticosteroid (ICS) response in adults and older children. But no conclusive studies have been carried out in young children.
The study, “Overweight/obesity status in preschool children associates with worse asthma but robust improvement on inhaled corticosteroids,” published in The Journal of Allergy and Clinical Immunology, investigated the association between weight, asthma and treatment response in preschoolers. ICS is a standard ashtma treatment.
Data from three large, multicenter Phase 3 clinical trials — INFANT (NCT01606306), PEAK (NCT00272441) and MIST (NCT00675584) — were analyzed by researchers. Their study included data on a total of 736 children, ages 2 to 5, randomized to receive daily ICS, intermittent ICS, or daily placebo. It compared annual asthma symptom days in overweight children, defined as those with a body mass index in the 85th percentile or higher, and those of normal weight.
Results showed that overweight children in the placebo group had more symptom-days (37, about five extra weeks) and flares or attacks in a given year than did normal weight children in that study group.
ICS treatment, however, reduced both asthma symptom-days and attacks in both groups, and was seen to be of added benefit to overweight children specifically. Those treated daily with ICS had fewer annual symptom-days that overweight children in the placebo group (90.7 vs. 41.2) and few flares (1.4 vs 0.6, respectively). “Similar protective ICS effects were less apparent” between daily ICS-treated and placebo-treated children of normal weight, the researchers wrote.
These findings are in contrast to results previously seen in older children.
“Reports in older children and adults with asthma who are overweight have shown a poor response to inhaled corticosteroids to manage their asthma,” Jason Lang, MD, of Duke Children’s Pulmonary Function Laboratory and lead researcher of the study, said in a press release. “This study suggests either pathways of inflammation are a bit different in preschool-aged patients, or that it takes years for obesity to reduce the effectiveness of steroid inhalers.”
He added: “Weight does not hamper the effectiveness of inhaled steroids in preschoolers, but this study provides clear evidence that maintaining a healthy weight in preschoolers may be an effective strategy for controlling asthma.”