Associations between body weight, asthma burden, and type 2 inflammation among under-resourced children.

BACKGROUND

Overweight/obesity is a risk factor for asthma, particularly in under-resourced children, and contributes to higher disease burden. Type 2 (T2) inflammation, a key characteristic of asthma endotypes, has been inconsistently associated with burden of obesity-related asthma, which may be due to limited overlap between different T2 features, including elevated total serum IgE level, eosinophilia, and allergen sensitization.

OBJECTIVE

To investigate the effects of different T2 features on association of overweight/obesity with asthma burden in under-resourced children.

METHODS

Among 2160 children aged 6 to 20 years from 4 Inner-City Asthma Consortium cohorts, the association of overweight/obesity with asthma burden (unscheduled visits, hospitalizations, exacerbations, asthma control, and pulmonary function) and the effect of T2 features (total IgE level higher than age-specific cutoffs, total eosinophils > 300 cells/µL, or sensitization to ≥2 allergens) on the association were investigated.

RESULTS

The odds (odds ratio [95% CI]) of unscheduled visits were higher among those with overweight/obesity (1.35 [1.04-1.75]) and allergen sensitization (1.35 [1.02-1.80]), hospitalizations were higher among those with elevated total IgE level (2.17 [1.27-3.69]) and eosinophilia (2.80 [1.56-5.21]), and poor asthma control was higher among those with elevated total IgE level (1.27 [1.09-1.41]). Overweight/obesity and all T2 features were associated with lower forced expiratory volume in 1 second/forced vital capacity ratio. There was no synergistic or clinically significant mediating influence of any of T2 features on the association of overweight/obesity with asthma burden.

CONCLUSION

Among under-resourced children with asthma, overweight/obesity and T2 inflammation are largely independently associated with unscheduled visits and pulmonary function deficits. T2 inflammation, but not overweight/obesity, is associated with poor control and hospitalizations.