Association of pediatric obesity and asthma, pulmonary physiology, metabolic dysregulation, and atopy; and the role of weight management

ABSTRACT

Introduction: Obesity affects about 40% of US adults and 18% of children. Its impact on the pulmonary system is best described for asthma.

Areas covered: We reviewed the literature on PubMed and Google Scholar databases and summarize the effect of obesity, its associated metabolic dysregulation and altered systemic immune responses, and that of weight gain and loss on pulmonary mechanics, asthma inception, and disease burden. We include a distinct approach for diagnosing and managing the disease, including pulmonary function deficits inherent to obesity-related asthma, in light of its poor response to current asthma medications.

Expert opinion: Given the projected increase in obesity, obesity-related asthma needs to be addressed now. Research on the contribution of metabolic abnormalities and systemic immune responses, intricately linked with truncal adiposity, and that of lack of atopy, to asthma disease burden, and pulmonary function deficits among obese children is fairly consistent. Since current asthma medications are more effective for atopic asthma, investigation for atopy will guide management by distinguishing asthma responsive to current medications from the non-responsive disease. Future research is needed to elucidate mechanisms by which obesity-mediated metabolic abnormalities and immune responses cause medication non-responsive asthma, which will inform repurposing of medications and drug discovery.

KEYWORDS:

• Asthma
• metabolic abnormalities
• obesity
• pulmonary function
• weight gain
• weight loss

Article highlights

• Obesity is an independent predictor of childhood asthma.

• Early life weight gain is associated with wheeze and incident asthma.

• Weight loss at any age is associated with improvement in asthma symptoms.

• Obesity impacts pulmonary physiology in multiple ways including inherent effect of adiposity, and via metabolic dysregulation and altered immune responses.

• Pulmonary function testing can help to distinguish effects of obesity on pulmonary physiology.

• Assessment for atopy may potentially help to distinguish asthma with co-existent obesity from incident asthma due to obesity.

• Assessment for metabolic dysregulation in obese children may help to identify obese children at risk for asthma.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was funded by a NIH NHLBI grant (K23HL118733).