Overweight kids at risk for asthma hospitalization

By Anthony J. Brown, MD

NEW YORK (Reuters Health) - Overweight children seen in the ER for an asthma flare-up are more likely to be admitted to the hospital than their non-overweight peers, according to a report in the journal Pediatrics. Moreover, this finding holds true regardless of illness severity.

"This is the first study in children to examine the relationship between overweight and hospital admission during asthma exacerbations," lead author Dr. Christopher L. Carroll, from Connecticut Children's Hospital in Hartford, told Reuters Health.

Carroll said his team was "somewhat surprised" by the main finding. "It suggests that obese children respond more slowly to therapy for acute exacerbations."

The findings are based on a review of all children, older than 2 years of age, who were seen for an asthma flare-up at the researchers' ER in 2005. Only children without other chronic medical conditions were included in the analysis. Overweight children were defined as being in the 95th or higher percentile of weight-for-age.

Overall, 813 children made 884 ER visits for asthma flare-ups during the study period, the authors report. Of these visits, 27 percent resulted in a hospital admission, including 4 percent that involved an intensive care unit admission.

Increasing asthma severity was associated with hospital admission, but age, gender, and poverty were not, the report indicates.

Of the ER visits made during the study, 77 percent involved a normal weight child and 23 percent involved an overweight child. On average, overweight children were older and were more likely to come from an impoverished area.

No major differences in asthma severity or in the ER treatment received were noted between overweight and normal-weight children. Nonetheless, 34 percent of ER visits involving an overweight child resulted in hospital admission compared with 25 percent of visits made by a normal weight child.

The main message is that "overweight children with asthma have significant health-related consequences as a result of their being overweight," Carroll said.

Still, further research is needed to better understand the relationship between body weight and asthma and the possible treatment implications, he said.

Asthma is a diverse disease, "with different subtypes that may require different treatment approaches. Accurate characterization of these subtypes may allow us to tailor therapies on a more individual basis. Overweight children with asthma may have a better response to different first-line therapies. Currently, we are conducting research to explore these areas."

SOURCE: Pediatrics, October 2007.