Obese children with asthma need higher corticosteroid doses

AAAAI: Corticosteroid Response in Asthma Impacted by BMI
AAAAI: Corticosteroid Response in Asthma Impacted by BMI

HealthDay News -- Overweight and obese children with asthma do not respond as well to corticosteroids as normal weight children and require higher daily doses of the medication, study data presented at the annual meeting of the American Academy of Allergy, Asthma & Immunology indicate.

"Chronic inflammation, as seen in obese patients, is thought to interfere with the body's response to corticosteroids, leading to a higher corticosteroid requirement in patients with asthma," Rolando A. Nunez, MD, from National Jewish Health in Denver, and colleagues reported at the meeting.

To determine the affects of BMI on corticosteriod response, the researchers studied peripheral blood mononuclear cells and bronchoalveolar lavage cells from 61 children with asthma, aged 2 to 18 years, who underwent clinically indicated bronchoscopies. Thirty-four children were normal weight, 13 were overweight and 14 were obese. Fifty-six participants used inhaled corticosteroids.

BMI percent correlated significantly with plasma leptin (P = 0.0001), daily inhaled corticosteriod dose (P = 0.0035), and dexamethasone-induced mitogen-activated protein kinase phosphatase-1 (MKP-1) in peripheral blood mononuclear cells and bronchoalveolar lavage cells (P = 0.0009 and 0.0205, respectively), the researchers found.

There was a negative association between MKP-1 induction and the daily requirement of inhaled cortocosteriods (P = 0.0303).

"Children with asthma demonstrate a decreased in vitro corticosteriod response with increasing BMI percentage that correlated with a higher daily inhaled corticosteriod requirement," the researchers reported.

Future studies should examine whether medication response might improve among obese children with asthma who lose weight, they added.

Nunez RA et al. "Body mass and corticosteroid response in childhood asthma." AAAAI 2012. Abstract #482.

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