In children with asthma who are overweight or obese, depressive symptoms may enhance airway compromise, according to a study published in the Journal of Allergy and Clinical Immunology Practice.

A total of 250 children with asthma between the ages of 7 and 17 years were included in this study. Patients were classified based on their body mass index (BMI) as having normal weight (mean BMI, 18.5; n=110; mean age, 11.5 years) or being overweight/obese (mean BMI, 27.5; n=140; mean age, 11.2 years). The Child Depression Inventory was used to assess the presence of depression. Among children without depression, 79 had normal weight (71.8%) and 109 were overweight/obese (77.9%). Among children with depression, 31 children had normal weight (28.2%) and 31 were overweight/obese (22.1%).

Pulmonary function was evaluated by measuring forced expiratory volume in 1 second (FEV1), and asthma severity was assessed according to the National Asthma Education and Prevention Program Expert Panel Report 3 criteria. The movie “E.T. The Extra-Terrestrial” was shown to participants to evoke emotional/stress and arousal. Airway resistance (Rint) was measured before and after film to identify airway function changes associated with emotional states triggered by the viewing. Parasympathetic/vagal and sympathetic reactivities were measured during the movie to assess autonomic nervous system reactivity.


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In children who were overweight/obese vs normal weight, symptoms of depression were found to be associated with lower FEV1 at baseline (P =.008). Additionally, higher depression scores predicted greater vagal bias under emotion stress/arousal (P =.009), and greater vagal bias was associated with increased Rint in the overweight/obese group (P =.023).

A limitation of this study was the inclusion of patients who were mostly from minority backgrounds, which may reduce the generalizability of the findings.

“Comorbid obesity and depression should be identified by clinicians for children with asthma. Treatment of these risk factors and/or anticholinergic inhaled medication as adjunct therapy may offer benefit in children with asthma, obesity, and depression,” concluded the study authors.

Reference

Hsu CY, Lehman HK, Wood BL, et al. Comorbid obesity and depressive symptoms in childhood asthma: A harmful synergy [published online April 15, 2020]. J Allergy Clin Immunol Pract. doi: 10.1016/j.jaip.2020.03.036