Body mass index and acute asthma severity among children presenting to the emergency department
ABSTRACT Ginde AA, Santillan AA, Clark S, Camargo CA Jr. Body mass index and acute asthma severity among children presenting to the emergency department. Pediatr Allergy Immunol 2010: 21: 480–488. © 2009 John Wiley & Sons A/S
To determine the prevalence of obesity among children presenting to the emergency department (ED) with acute asthma, and to examine the relationship between body mass index (BMI) and acute asthma severity in the ED setting. We analyzed data from a multicenter prospective cohort study during 1997–1998; 44 ED in 17 US states and two Canadian provinces enrolled 672 patients, age 5–17, with acute asthma. BMI and Pulmonary Index were collected in the ED. We defined overweight and obesity using age, sex, and race-specific BMI values from national and international databases. The prevalence of obesity was significantly higher among ED patients with acute asthma as compared with children from the general population (23% vs. 9–15%; p < 0.001). Obese children with acute asthma did not differ from their non-obese counterparts, by demographic factors or chronic asthma severity (all p > 0.2). Initial Pulmonary Index was the same across underweight, intermediate, and obese groups (3.7 ± 2.4, 3.8 ± 2.2, 3.7 ± 2.3; p = 0.70). Admission status also did not vary across groups (22%, 22% and 23%; p = 0.98). Stratifying the analysis by age group and sex did not change these results. The prevalence of obesity among children presenting to the ED with acute asthma was significantly higher compared with children from the general population. BMI was not associated with markers of chronic and acute asthma severity. The results of this study support a positive association between obesity and asthma, and suggest that asthma exacerbations among obese children are very similar to those experienced by other children.
- SourceAvailable from: Masako Suzuki
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- "Obesity and asthma are common and debilitating conditions that are especially prevalent in urban Hispanic and African American populations12. Over the past decade, obesity is recognized as an independent risk factor for asthma34567 and is associated with greater morbidity compared to asthma in normal-weight children89. Mechanistic studies suggest that obesity-associated asthma is a distinct entity, but its pathophysiology remains poorly defined10. "
ABSTRACT: While DNA methylation plays a role in T-helper (Th) cell maturation, its potential dysregulation in the non-atopic Th1-polarized systemic inflammation observed in obesity-associated asthma is unknown. We studied DNA methylation epigenome-wide in peripheral blood mononuclear cells (PBMCs) from 8 obese asthmatic pre-adolescent children and compared it to methylation in PBMCs from 8 children with asthma alone, obesity alone and healthy controls. Differentially methylated loci implicated certain biologically relevant molecules and pathways. PBMCs from obese asthmatic children had distinctive DNA methylation patterns, with decreased promoter methylation of CCL5, IL2RA and TBX21, genes encoding proteins linked with Th1 polarization, and increased promoter methylation of FCER2, a low-affinity receptor for IgE, and of TGFB1, inhibitor of Th cell activation. T-cell signaling and macrophage activation were the two primary pathways that were selectively hypomethylated in obese asthmatics. These findings suggest that dysregulated DNA methylation is associated with non-atopic inflammation observed in pediatric obesity-associated asthma.Scientific Reports 07/2013; 3:2164. DOI:10.1038/srep02164 · 5.58 Impact Factor
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