Are Children With Obesity and Asthmatic Symptoms Being Overtreated?

obese boy holding his chest
obese boy holding his chest
A diagnosis of asthma, using standard questionnaires that assess symptoms and lung function tests, should be confirmed in children before commencing medication.

A diagnosis of asthma, using standard questionnaires that assess symptoms and lung function tests, should be confirmed in children before the commencement of medication. A retrospective, cross-sectional, observational cohort study was conducted among a group of children with obesity or overweight who had visited the pediatric outpatient clinic of St. Antonius Hospital in Nieuwegein/Utrecht, The Netherlands, between January 2013 and July 2016 because of asthmatic symptoms. Results of the study were published in BMC Pediatrics.1

Recognizing the possible association between asthma and obesity, investigators sought to evaluate the prevalence of overtreatment with asthma medication in a cohort of children with obesity with respiratory symptoms who had been seen at a pediatric outpatient clinic. Patients between 4 and 18 years of age who were overweight or obese and had symptoms of asthma were included in the study.

Patients were considered to have asthmatic symptoms if β2-agonist or inhaled corticosteroid therapy had been prescribed for them and/or a diagnosis of asthma was recorded in their medical file. The patients were classified as being overweight or obese, based on national cutoff values for age- and sex-adjusted body mass index standard deviation score (BMI-sds). Overweight and obesity were defined as BMI-sds >1.1 and ≤2.3 (for overweight) and BMI-sds >2.3 (for obesity).2

The diagnosis of asthma was evaluated and was classified as no asthma, unlikely asthma, probable asthma, or confirmed asthma, according to clinical parameters and/or results of spirometry testing. A total of 338 participants were included in the analysis. Overall, 92.6% (313 of 338) of the patients had a prescription for an asthma medication. Overtreatment was reported in 27.2% (92 of 338) of the participants, according to the definition set forth by the researchers (prescribing an asthma medication to participants with no or unlikely asthma).

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These findings highlight the need for confirmation of an asthma diagnosis before treatment. Additional studies regarding the overtreatment with asthma medication in normal-weight pediatric populations are warranted to explore whether overtreatment is limited to children who are overweight or obese.


  1. Lentferink YE, Boogaart NE, Balemans WAF, Knibbe CAJ, van der Vorst MMJ. Asthma medication in children who are overweight/obese: justified treatment? BMC Pediatr. 2019;19(1):148. doi:10.1186/s12887-019-1526-3
  2. Hirasing RA, Fredriks AM, van Buuren S, Verloove-Vanhorick SP, Wit JM. Increased prevalence of overweight and obesity in Dutch children, and the detection of overweight and obesity using international criteria and new reference diagrams. Ned Tijdschr Geneeskd. 2001;145(27):1303-1308.