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Obesity Predicts Shorter Time to First Exacerbation in Pediatric Patients with Uncontrolled Mild to Moderate Asthma

Longo, Cristina; Bartlett, Gillian; MacGibbon, Brenda; Ducharme, Francine M; Barnett, Tracie A (2016). Obesity Predicts Shorter Time to First Exacerbation in Pediatric Patients with Uncontrolled Mild to Moderate Asthma In: 32nd International Conference on Pharmacoepidemiology & Therapeutic Risk Management, August 25–28, 2016, The Convention Centre Dublin, Dublin, Ireland.

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Résumé

Background: Although childhood obesity has been linked to poor asthma control, other studies have re- futed this claim. Such inconsistencies may be due to the lack of clinical severity indicators and asthma diag- nosis ascertainment in administrative databases; thus, the effect of weight status on asthma control remains to be elucidated in children using clinical data.

Objectives: To assess if BMI percentile is a significant predictor of time to first exacerbation among children with mild to moderate uncontrolled asthma.

Methods: We conducted a retrospective cohort study from clinical data linked to health and drug administra- tive databases. The cohort consisted of children aged 5-18 years with confirmed asthma, followed by the Montreal Children’s Hospital’s Asthma Center (AC) from January 1 2000 to September 31 2007 in QC, Canada. Patients were included at cohort entry if they were newly stepped-up to a higher-dose inhaled corti- costeroid (ICS) monotherapy (MT) or ICS combina- tion therapy (CT),i.e. with Long-Acting Beta2- Agonists or Leukotriene Receptor Antagonists as add-on therapies, from a low-dose ICS regimen. Ex- clusion criteria were: bronchopulmonary dysplasia, cystic fibrosis, or not covered by the public drug insur- ance plan. Patients were followed until the date of first exacerbation, lost-to-follow-up or end of 1-year fol- low-up, whichever occurred first. Age- and sex-spe- cific BMI percentiles were computed using the WHO growth charts at cohort entry and subsequent AC visits. Exacerbation was defined as any ED visit, hos- pitalization, or use of oral corticosteroids for asthma. A Cox model was used to determine the effect of time-varying BMI percentile on hazard of first exacerbation.

Results: The final sample consisted of 355 children newly stepped-up to ICS MT (N = 252) or ICS CT (N=103), with 234 (65.9%) events during follow-up. For every 10 unit increase in BMI percentile, the haz- ard of exacerbation increased by 31% (HR 1.31, 95% CI 1.20-1.43), after adjusting for confounders.

Conclusions: Excess weight is an important predictor of exacerbation-free time in pediatric asthma. Further research is warranted to understand the pathology of obese-asthma in children.

Type de document: Document issu d'une conférence ou d'un atelier
Informations complémentaires: Pharmacoepidemiology and Drug Safety 25(suppl 3):179 Meeting Abstract: 305 10.1002/pds
Mots-clés libres: -
Centre: Centre INRS-Institut Armand Frappier
Date de dépôt: 26 févr. 2019 21:29
Dernière modification: 26 févr. 2019 21:29
URI: http://espace.inrs.ca/id/eprint/5760

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