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Weight status and time to first exacerbation in children with asthma: is there a dose–response relationship?

Longo, Cristina; Bartlett, Gillian; Ducharme, Francine M.; Schuster, Tibor; MacGibbon, Brenda; Barnett, Tracie A . Weight status and time to first exacerbation in children with asthma: is there a dose–response relationship? In: Canadian Society of Allergy and Clinical Immunology annual scientific meeting 2016, 28 septembre-2 octobre 2017, Montréal (Canada).

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Résumé

Background: Obesity has been linked with poor asthma control and decreased response to inhaled corticosteroids (ICS). However, other studies have refuted these claims.

Objective: To determine if weight status has a dose–response relationship with time to first exacerbation among children with asthma.

Method: A historical cohort study was conducted from a clinical database that was linked to health and drug administrative databases. The cohort consisted of children aged 2–18 years with specialist-confirmed asthma, who consulted with the Asthma Centre (AC) of the Montreal Children’s Hospital between April 1st, 2000 and September 31st, 2007 in Quebec, Canada. We included children initiating higher-dose ICS monotherapy (MT) or ICS combination therapy (CT) at the clinic index date. We excluded children with: bronchopulmonary dysplasia, cystic fibrosis, or no public drug insurance coverage. The cohort end date was the date of first exacerbation, end of health insurance coverage, or end of 1-year follow-up, whichever occurred first. Sex-specific BMI for age percentiles were calculated using the WHO growth charts. Exacerbation was defined as an emergency department visit, hospital admission, or use of oral corticosteroids for asthma. A Cox model was used to assess the dose response between weight status, i.e. using BMI percentile categories, on the hazard of first exacerbation.

Results: 328 children were incident users of ICS MT (N = 231) or ICS CT (N = 97), with 234 (65.9%) events during follow-up. When compared to children in the 44th BMI percentile or less category, those belonging to the 45th to 64th BMI percentile class had a HR of 2.25 (95% CI 0.93–5.41), 65th to 84th BMI percentile had a HR of 4.35 (95% CI 0.99–19.01), and 85th BMI percentile or more had a HR of 8.36 (95% CI 1.09–64.08).

Conclusions: This study is the first to demonstrate the dose–response relationship between weight status and exacerbation-free time in pediatric asthma.

Type de document: Document issu d'une conférence ou d'un atelier
Informations complémentaires: Allergy, Asthma, and Clinical Immunology, 13 (Suppl 1):16
Mots-clés libres: -
Centre: Centre INRS-Institut Armand Frappier
Date de dépôt: 10 sept. 2018 20:52
Dernière modification: 10 sept. 2018 20:58
URI: http://espace.inrs.ca/id/eprint/7525

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