IMPACT OF OBESITY ON ASTHMA CONTROL AND PULMONARY FUNCTION IN ASTHMATIC CHILDREN: A CROSS-SECTIONAL STUDY
DOI:
https://doi.org/10.56238/arev8n2-083Keywords:
Asthma, Obesity, Child, Asthma Control, Pulmonary FunctionAbstract
BACKGROUND: Asthma and childhood obesity are globally growing public health challenges. Obesity is recognized for exacerbating asthma control in children, with pathophysiological mechanisms contributing to pulmonary dysfunction. Understanding this complex interaction is crucial for effective clinical management and the development of appropriate health strategies. AIMS: The main objective was to analyze the impact of obesity on asthma control and pulmonary function in asthmatic children. METHODS: A cross-sectional study was conducted with 165 asthmatic children and adolescents followed in specialized outpatient clinics. Medical record data were used to evaluate Body Mass Index (BMI) using Z-scores to classify overweight/obesity, asthma control (GINA criteria and Asthma Control Test - ACT), and pulmonary function (spirometry). Statistical significance was set at p < 0.05. RESULTS: The sample had a mean age of 11.00 ± 3.21 years, with 61.21% male participants and 34.50% presenting overweight/obesity. A significant association was observed between overweight/obesity and worse asthma control (GINA: p=0.047; ACT: p=0.041). However, no significant differences were observed in most conventional spirometric parameters between the groups. CONCLUSIONS: Obesity in asthmatic children was significantly associated with worse disease control, even in the absence of significant changes in traditional pulmonary function tests. This reinforces the need for integrated approaches, including nutritional monitoring and promotion of physical activity, in the management of pediatric asthma.
Downloads
References
1. ABU ZAHRA, M.; PESSIN, J.; RASTOGI, D. A clinician's guide to effects of obesity on childhood asthma and into adulthood. Expert Review of Respiratory Medicine, v. 18, n. 10, p. 759–775, 2024. DOI: 10.1080/17476348.2024.2403500. Disponível em: https://doi.org/10.1080/17476348.2024.2403500.
2. BRASIL. Ministério da Saúde. Em 2021, SUS registrou 1,3 milhão de atendimentos a pacientes com asma na Atenção Primária à Saúde. Brasília, DF, 3 maio 2022. Disponível em: https://www.gov.br/saude/pt-br/assuntos/noticias/2022/maio/em-2021-sus-registrou-1-3-milhao-de-atendimentos-a-pacientes-com-asma-na-atencao-primaria-a-saude-1.
3. CARVALHO-PINTO, R. M. de et al. Recomendações para o manejo da asma grave da Sociedade Brasileira de Pneumologia e Tisiologia – 2021. Jornal Brasileiro de Pneumologia, v. 47, n. 6, e20210273, 2021. DOI: 10.36416/1806-3756/e20210273. Disponível em: https://doi.org/10.36416/1806-3756/e20210273.
4. DI CICCO, M. et al. Pediatric obesity and severe asthma: Targeting pathways driving inflammation. Pharmacological Research, v. 188, p. 106658, 2023. DOI: 10.1016/j.phrs.2023.106658. Disponível em: https://doi.org/10.1016/j.phrs.2023.106658.
5. DIXON, A. E.; POYNTER, M. E. Mechanisms of asthma in obesity: pleiotropic aspects of obesity produce distinct asthma phenotypes. American Journal of Respiratory Cell and Molecular Biology, v. 54, n. 5, p. 601-608, 2016. DOI: https://doi.org/10.1165/rcmb.2016-0017PS.
6. GLOBAL INITIATIVE FOR ASTHMA. Global Strategy for Asthma Management and Prevention, 2025 update. Fontana, WI: GINA, 2025. Disponível em: https://ginasthma.org.
7. JAYASOORIYA, S. M. et al. Asthma: epidemiology, risk factors, and opportunities for prevention and treatment. The Lancet Respiratory Medicine, v. 13, n. 8, p. 725-738, 2025. DOI: https://doi.org/10.1016/S2213-2600(24)00383-7.
8. KHALAF, Z. et al. Influence of age on clinical characteristics, pharmacological management and exacerbations in children with asthma. Thorax, v. 79, n. 2, p. 112-119, 2024. DOI: https://doi.org/10.1136/thorax-2023-220603.
9. NORIEGA, N. et al. Effect of obesity on lung function in the pediatric and adult populations with asthma: a review. Journal of Clinical Medicine, v. 12, n. 16, p. 5385, 19 ago. 2023. DOI: https://doi.org/10.3390/jcm12165385.
10. NYAMBUYA, T. M. et al. Obesity-related asthma in children is characterized by T-helper 1 rather than T-helper 2 immune response: A meta-analysis. Annals of Allergy, Asthma & Immunology, v. 125, n. 4, p. 425–432.e4, 2020. DOI: 10.1016/j.anai.2020.06.020. Disponível em: https://doi.org/10.1016/j.anai.2020.06.020.
11. REYES-ANGEL, J. et al. Obesity-related asthma in children and adolescents. The Lancet Child & Adolescent Health, v. 6, n. 10, p. 713–724, 2022. DOI: https://doi.org/10.1016/S2352-4642(22)00185-7
12. SCHMIDT, V. et al. Obesity-mediated immune modulation: One step forward, (Th)2 steps back. Frontiers in Immunology, v. 13, p. 932893, 30 jun. 2022. DOI: 10.3389/fimmu.2022.932893. Disponível em: https://doi.org/10.3389/fimmu.2022.932893.
13. VEZIR, E. et al. Effects of obesity on airway and systemic inflammation in asthmatic children. International Archives of Allergy and Immunology, v. 182, n. 8, p. 679–689, 2021. DOI: 10.1159/000513809. Disponível em: https://doi.org/10.1159/000513809.
14. KRIVOŠOVÁ, M. et al. Exploring the Asthma–Obesity Link Using Advanced Imaging Techniques. Physiological Research, Prague, v. 74, p. 19-29, 2025. DOI: 10.33549/physiolres.935390. Disponível em: https://doi.org/10.33549/physiolres.935390
15. UNIVERSIDADE FEDERAL DO RIO DE JANEIRO. Estado Nutricional Antropométrico da Criança e da Mãe: Prevalência de indicadores antropométrico de crianças brasileiras menores de 5 anos de idade e suas mães biológicas: ENANI 2019. - Documento eletrônico. - Rio de Janeiro, RJ: UFRJ, 2022. (96 p.). Coordenador geral, Gilberto Kac. Disponível em: https://enani.nutricao.ufrj.br/index.php/relatorios/.
16. Tosca, Maria Angela; SCHIAVETTI, Irene; CIPRANDI, Giorgio; Grupo de Estudos ControL’Asma. Obesidade e asma: uma ligação intrigante na infância e adolescência. International Archives of Allergy and Immunology, Basel, v. 182, n. 12, p. 1222–1225, 2021. DOI: 10.1159/000517298.
17. CASSOL, V. E.; RIZZATO, T. M.; TECHE, S. P.; BASSO, D. F.; HIRAKATA, V. N.; MALDONADO, M.; COLPO, E.; SOLÉ, D. Prevalência e gravidade da asma em adolescentes e sua relação com índice de massa corporal. Jornal de Pediatria (Rio de Janeiro), v. 81, n. 4, p. 305-309, 2005. Disponível em: https://doi.org/10.1590/S0021-75572005000500008
18. QUANJER, P. H.; HALL, G. L.; STANOJEVIC, S.; COLE, T. J.; STOCKS, J. Age and height-based prediction bias in spirometry reference equations. European Respiratory Journal, v. 40, n. 1, p. 190-197, 2012. DOI: https://doi.org/10.1183/09031936.00161011.
19. SCHATZ, M.; SORKNESS, C. A.; LI, J. T.; MARCUS, P.; MURRAY, J. J.; NATHAN, R. A.; KOSINSKI, M.; PENDERGRAFT, T. B.; JHINGRAN, P. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. Journal of Allergy and Clinical Immunology, v. 117, n. 3, p. 549–556, 2006. DOI: 10.1016/j.jaci.2006.01.011. Disponível em: https://pubmed.ncbi.nlm.nih.gov/16522452/.
20. ZHANG, Xinhui; WANG, Wen; WANG, Wanqi; WANG, Zhuiyue; XU, Anran; XUE, Zheng. An analysis of the global burden of childhood and adolescent asthma attributable to high BMI: 1990–2021. Frontiers in Pediatrics, v. 13, p. 1646693, 2025. DOI: 10.3389/fped.2025.1646693.
21. DELIEGEORGOPOULOU, M.; TSABOURI, S.; SIOMOU, E.; VLAHOS, A. P.; SERBIS, A. Dietary habits and their impact on pediatric obesity and asthma: narrative review with emphasis on the Mediterranean diet. Children, v. 12, n. 10, p. 1354, 2025. DOI: 10.3390/children12101354. Disponível em: https://www.mdpi.com/2227-9067/12/10/1354.
22. CHAROENSITTISUP, P. et al. Longitudinal effects of obesity on pulmonary function in obese children and adolescents. Pediatric Research, 2024. DOI: 10.1038/s41390-024-03544-2. Disponível em: https://www.nature.com/articles/s41390-024-03544-2.
23. JESUS, Juliana Pires Viana de et al. Obesidade e asma: caracterização clínica e laboratorial de uma associação frequente. Jornal Brasileiro de Pneumologia, Brasília, v. 44, n. 3, p. 207–212, 2018 DOI: 10.1590/S1806-37562017000000034.
24. Pazini, F.; Pietta-Dias, C.; Roncada, C. Relação entre níveis de atividade física, índices antropométricos e função pulmonar de escolares. Revista Paulista de Pediatria, v. 39, e2019189, 2021. DOI: 10.1590/1984-0462/2021/39/2019189.