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The Obese-Asthma Phenotype in Children: An Exacerbating Situation?

Longo, Cristina; Bartlett, Gillian; Schuster, Tibor; Ducharme, Francine M.; MacGibbon, Brenda; Barnett, Tracie A (2018). The Obese-Asthma Phenotype in Children: An Exacerbating Situation? Journal of Allergy and Clinical Immunology , vol. 141 , nº 4. p. 1239-1249. DOI: 10.1016/j.jaci.2017.10.052.

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Résumé

BACKGROUND: Current evidence regarding the relationship between childhood obesity, decreased response to inhaled corticosteroids (ICSs), and poor asthma control is conflicting.

OBJECTIVES: We assessed whether obesity (1) is associated with time to first exacerbation among children with asthma initiating step 3 maintenance therapies and (2) modifies the effectiveness of step 3 therapies.

METHODS: A retrospective cohort study was conducted from clinical data linked to health and drug administrative databases. The cohort consisted of children aged 2 to 18 years with specialist-confirmed asthma who initiated medium/high-dose ICS monotherapy or low/medium-dose ICS with leukotriene receptor antagonist/long-acting β-agonist (combination therapy) at the Montreal Children's Hospital Asthma Center from 2000 to 2007. Children were classified as exposed to step 3 therapies when they were dispensed a corresponding drug claim during follow-up, whereas those without claims were classified as nonadherers. Marginal structural Cox models were used to estimate the effect of obesity (body mass index > 97th percentile) and treatment on time to exacerbation, which was defined as any emergency department visit, hospitalization, or use of oral corticosteroids for asthma.

RESULTS: Of the 4621 cohort patients, 231 initiated ICS monotherapy, and 97 initiated combination therapy. The hazard ratio (HR) for obesity was 1.67 (95% CI, 1.41-1.98). Compared with nonobese nonadherers, the HR for obese nonadherers was 1.54 (95% CI, 0.97-2.45); the HR for ICS monotherapy in obese and nonobese children was 0.85 (95% CI, 0.47-1.52) and 0.58 (95% CI, 0.37-0.91), respectively; and the HR for combination therapy in obese and nonobese children was 0.50 (95% CI, 0.13-1.89) and 0.46 (95% CI, 0.23-0.92), respectively.

CONCLUSION: Obesity might be a determinant of shorter exacerbation-free time in children with asthma; however, we could not rule out a differential response to step 3 therapies by obesity status, potentially because of a lack of precision.

Type de document: Article
Mots-clés libres: Asthma; inhaled corticosteroid combination therapy; inhaled corticosteroid monotherapy; marginal structural Cox model; obesity
Centre: Centre INRS-Institut Armand Frappier
Date de dépôt: 04 mars 2019 18:19
Dernière modification: 04 mars 2019 18:19
URI: http://espace.inrs.ca/id/eprint/7468

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