Chest
Volume 140, Issue 6, December 2011, Pages 1524-1533
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Original Research
Asthma
Does Age Impact the Obese Asthma Phenotype?: Longitudinal Asthma Control, Airway Function, and Airflow Perception Among Mild Persistent Asthmatics

https://doi.org/10.1378/chest.11-0675Get rights and content

Background

The relationship between obesity and asthma remains inadequately defined. Studies about how obesity affects asthma control and lung function show conflicting results. Additional focus on the effect of age as a modifier may make clearer the interaction between obesity and asthma phenotype. We sought to use a diverse and well-phenotyped cohort of asthmatic patients to determine how age impacts the relationship between obesity and spirometry, peak flow variability, airflow perception, and asthma control.

Methods

The characteristics of 490 patients with mild persistent asthma taken from 2,794 study visits from a prospective trial studying strategies of step-down therapy were included in this post hoc analysis. A longitudinal mixed-effect model was used to determine if age affects the relationship between obesity and asthma characteristics, including spirometry, asthma control, airway pH, and perception of airflow changes.

Results

The effect of obesity on asthma outcomes changes with age and gender. Obese 6- to 11-year-old children had the largest reduction in lung function but reported relatively fewer asthma symptoms than did similar nonobese asthmatics. Obese 12- to 17-year-olds showed a trend toward greater airflow obstruction and asthma symptoms compared with nonobese asthmatics. Adults in general displayed few obesity-related alterations in asthma phenotype. Female gender among 12- to 17- and 18- to 44-year-olds was associated with greater obesity-related asthma impairment.

Conclusions

Age is a significant effect modifier on the relationship between obesity and asthma phenotype. With increasing age, the influence of obesity on the asthma phenotype is generally reduced. The asthma phenotype may be most impacted by obesity among children and women.

Section snippets

Materials and Methods

Details of the main study design have been published elsewhere.26 All participants signed written informed consents. The study was approved by the Nemours Florida institutional review board (03-016) and by all other American Lung Association Asthma Clinical Research Centers network institutional review boards. We included data from 2,794 study visit encounters involving 490 participants aged 6 to 76 years with mild persistent asthma randomized into a 16-week multicenter asthma trial assessing

Baseline Characteristics

The baseline characteristics at randomization of 490 children, adolescents, and adults are shown by age group (Table 3). Approximately 60% of participants were between 18 and 44 years of age. Adults (18 to 76 years old) tended to be female, whereas younger participants were more likely to be male (Table 3). There was a significantly higher prevalence of blacks (50%) among children than among adolescents (34%) and adults (24%). Overweight/obese prevalence increased with advancing age among the

Discussion

Obesity is a risk factor for new asthma across a broad age range1, 2, 3, 4, 5, 27 and may complicate asthma control.17, 22, 28 After assessing lung function, breath pH, airflow lability, symptom control, and airflow perception among obese and nonobese participants, we conclude that age is an important effect modifier in the obesity-asthma relationship and, along with gender, is a primary covariate determining the obese-asthma phenotype.

In summary, young children appeared to be most affected by

Acknowledgments

Author contributions: Dr Lang vouches for the integrity of the data and the accuracy of the data analysis.

Dr Lang: contributed to the conception and design of the study; acquisition, analysis, and interpretation of data; and drafting of the submitted manuscript.

Dr Hossain: contributed to the analysis and interpretation of data and critical revision of the manuscript for important intellectual content.

Dr Dixon: contributed to the design of the study, acquisition of data, and critical editing of

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    Funding/Support: This study was supported by an unrestricted grant from GlaxoSmithKline, which also supplied drugs and placebos for the parent trial, and a grant from the American Lung Association.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

    *

    A complete list of the American Lung Association Asthma Clinical Research Centers can be found in e-Appendix 1.

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