The relationship between asthma and obesity has been unclear. Lang et al. (10.1542/peds.2018-2119) conducted a study elegantly designed to determine just how much risk for asthma can we attribute to being overweight or obese. The authors share with us the results of a retrospective cohort study involving more than 500,000 children in eight large US health systems using a strict definition for asthma with diagnostic confirmation using spirometry. The authors controlled for confounders and found when doing so, that the risk of asthma was increased 23-28% in children with obesity and that in the absence of being overweight or obese, 10-13% of cases of asthma could theoretically be avoided.
This is important information and opens new doors to reducing the incidence of asthma by focusing on ways to address obesity. To help make sense of this study and provide more information on what we know about obesity-related asthma compared to allergic-related asthma, we invited a specialist on this topic, Dr. Deepa Rastogi from Montefiore (10.1542/peds.2018-2979) to shares her perspective on this study and its importance in an accompanying commentary. Dr. Rastogi points out how solid the findings are in this study due to its elegant methodology, and then educates us on the fact that obesity-related asthma is much more poorly responsive to usual asthma medications as compared to normal-weight allergic asthma. She strongly encourages us to consider screening children who are overweight or obese with spirometry to monitor for signs of asthma and also charges investigators who study asthma to continue to work harder to find therapeutic avenues to treat this breathing problem since the conventional therapies we have work less well in obesity-related asthma. Are you getting spirometry routinely in your overweight or obese patients even if they have not reported wheezing to you? Take a deep breath, read both the study and commentary, and consider the implications.
