Childhood Asthma in a Pediatric Obesity Group: Effect of Weight Loss, Exercise, and Healthy Lifestyle

Abstract

PURPOSE: Increase in obesity parallels the rising asthma prevalence among children and adolescents. The Fit Kids for Life 10-week program enrolls obese children and adolescents to provide guidance for healthier living. Determining asthma prevalence and examining quality of life (QOL) and respiratory symptoms will be useful in implementing asthma education into this existing program. METHODS: This study was approved by our Institutional Review Board. Eligibility criteria: ages 8 to 17 years, body mass index (BMI) ≥ 95th percentile. Subjects completed baseline evaluation, spirometry, six minute walk, methacholine challenge (if indicated) and allergy skin testing as objective measures for asthma diagnosis. Questionnaires-PedsQL 4.0 Generic Core Scales, PedsQL 3.0 Asthma Module, and Asthma Control Test (ACT) were administered. RESULTS: Ten subjects (3 male, 7 female) completed baseline visits, with mean age of 11 ± 2 years and mean BMI of 97th percentile ± 0.011. Spirometry showed lower values compared to established predicted values. Most subjects' (n=9) six minute walk ranged 400-690 meters. One subject walked 255 meters, complaining of severe dyspnea, but no desaturation observed for any subjects. One qualified for methacholine challenge and showed no airway hyperreactivity. Allergies were positive in 6/10. Asthma was diagnosed in 9/10 subjects. Mean scores for physical health (78%) and emotional functioning (76%) dimensions fall below the overall total score of 79% for general QOL. Asthma QOL showed difficulty with symptoms such as chest tightness, cough, and feeling wheezy, and issues with communicating their asthma with peers. However, ACT in 8 subjects scored >19 (range: 21-25) indicating their asthma was in good control. CONCLUSION: Our initial sample of obese children showed high asthma prevalence. General QOL and respiratory symptoms seemed to be affected. CLINICAL IMPLICATIONS: This ongoing study will explore whether a decrease in BMI will lead to improved pulmonary function. Asthma education may be directed at these QOL dimensions that subjects showed most difficulty, such as communication. Providers should elicit the effect of obesity on asthma and incorporate targeted education in this special population.