Children who were obese and had asthma were more often prescribed oral corticosteroids, possibly indicating poorer symptom control, compared with their nonobese counterparts, regardless of ethnicity, according to a study published in the Journal of Asthma.
Poorer asthma outcomes are often observed when patients have comorbid obesity, partially owing to reduced controller medication responses that may lead to uncontrolled asthma, requiring management with oral steroids. This phenomenon has remained largely unexplored in the Latino pediatric community, and it is unclear whether ethnic disparities exist between Hispanic and non-Hispanic populations in terms of steroid prescriptions. Investigators sought to determine the nature and degree of the obesity-steroid connection within their sample and also to examine potential ethnic differences in this relationship.
Electronic health records provided data from the Accelerating Data Value Across a National Community Health Center Network (ADVANCE) Clinical Data Research Network on American children between 5 and 17 years of age diagnosed with asthma who visited a community health clinic at least once from 2012 to 2017. Data from a total of 16,763 patients (56.0% boys; 63.8% Latino and 36.2% non-Hispanic white) were analyzed.
The primary outcome was the number of oral glucocorticoid (dexamethasone, prednisone, prednisolone, or methylprednisolone) courses prescribed over the study period, while the primary independent variables were weight status by body mass index and ethnicity. Poisson regression was performed using generalized estimating equations to assess oral steroid prescription rates overall and according to ethnicity, after adjustment for potential confounders. Rate ratios (RRs) and 95% CI were reported.
The majority of patients had public insurance (81.4%), with 42.2% reporting 1 to 2 clinic visits per year. Among all participants, 39.1% were always overweight/obese, 38.0% were never overweight/obese, and 22.9% were sometimes overweight. Most children (91.0%) were given an average of <1 oral steroid prescription per year.
When considering all children, individuals who were sometimes or always overweight/obese saw increases of 11% (RR = 1.11; 95% CI, 1.03-1.20) and 14% (RR = 1.14; 95% CI, 1.06-1.22), respectively, in oral steroid prescription rates. Compared with Latino children categorized as never overweight/obese, sometimes overweight/obese Latino children received 11% more prescriptions (RR = 1.11; 95% CI, 1.01-1.21), while always overweight/obese Latino children were prescribed oral steroids at a 15% higher rate (RR = 1.15; 95% CI, 1.05-1.26). There were similar but nonsignificant effects observed for non-Hispanic white children when comparing always (RR = 1.10; 95% CI, 0.92-1.33) and sometimes (RR = 1.11; 95% CI, 0.81-1.36) overweight/obese vs never overweight/obese participants.
There was no disparity found by ethnicity in terms of the association between obesity and oral steroid prescription rates. Ethnicity/ body mass index interactions were determined to be nonsignificant for both the sometimes overweight/obese (P =.95) and always overweight/obese (P =.58) groups.
Study limitations included likely missed prescriptions secondary to a lack of hospital and emergency department data, the possibility that single yearly prescriptions could provide up to 12 monthly refills, lack of pharmacy data to confirm filling of prescriptions, uncertainty regarding the impact and directionality of weight on asthma and vice versa, and a cross-sectional design that precluded causal inferences.
“Our findings indicate that children with comorbid asthma and overweight or obesity have poorer asthma control than children who have always been healthy weight, and they may require more attentive treatment to provide quality asthma care,” noted the authors. They recommended that future research involve various symptom frequencies and severities, other racial/ethnic groups, and exploration of controller medication adherence.
Funding and Conflicts of Interest Disclosures:
This work was supported by the NIH National Institute on Minority Health and Health Disparities under grant number R01MD011404; and the National Institute on Drug Abuse under grant number K23-DA037453.
The authors have no conflicts of interest to disclose.
Lucas JA, Marino M, Fankhauser K, et al. Oral corticosteroid use, obesity, and ethnicity in children with asthma [published online August 22, 2019]. J Asthma. doi:10.1080/02770903.2019.1656228