Obese Asthmatics Overuse Rescue Medications

As a result of confusing sensations of breathlessness with asthma symptoms, overweight and obese children tend to report poorer asthma control and overuse rescue medications, new research published online on October 14, 2014, in the Journal of Allergy and Clinical Immunology suggests.

Across 3 clinic visits, Jason E. Lang, MD, MPH, a physician and researcher at Nemours Children’s Hospital in Orlando, Florida, and his colleagues reviewed the lung function, treatment use, symptom patterns, and asthma-related quality of life of 58 children aged 10 to 17 years with early-onset, persistent asthma who received daily controller treatment.

After grouping the children by body mass index (BMI), the researchers found the subjects who were overweight or obese reported clinically worse asthma symptoms than their leaner counterparts. Moreover, the overweight and obese children more often reported shortness of breath and less often reported cough, and their gastroesophageal reflux disease (GERD) scores were higher.

In mistaking their dyspnea and GERD for asthma, the overweight and obese children engaged in greater short-acting beta-agonist (SABA) use than the lean subjects, the researchers found.

“These data suggest that overweight/obese children with asthma, on average, experience and report asthma differently than do lean children and that the greater obesity-related poor asthma control is driven to a large extent by shortness of breath and self-medication with SABAs,” the study authors concluded. “These excess symptoms may not stem technically from asthma but, rather, from obesity-related sequelae, such as GERD, chest restriction, or excess demand on the respiratory system. Instead of obesity-related GERD and chest restriction mediating worse asthma, these processes may cause dyspnea, which is confused for asthma and leads to worse patient-reported asthma control scores.”

The researchers noted that SABA overuse among obese children with asthma has been shown to reduce lower esophageal sphincter tone, which perpetuates a cycle of GERD, chest symptoms, and further SABA use.

“Obese children with asthma need to develop a greater understanding of the distinct feeling of breathlessness in order to avoid not just unnecessary medication use, but also the anxiety, reduced quality of life, and health care utilization that come along with this misunderstood symptom,” Dr. Lang said in a press release. “Alleviating this overuse of rescue medications could likely also lessen other symptoms obese children with asthma are impacted by, including most notably acid reflux.”