Schmauck-Gómez J S, Menrath I, Kaiser M M, Herz A, Kopp M V
Airway Research Center North (ARCN), Member of the German Center for Lung Research (DZL).
Department of Pediatric Surgery, University Hospital of Schleswig-Holstein, Luebeck.
Klin Padiatr. 2016 Jul;228(4):189-94. doi: 10.1055/s-0042-102254. Epub 2016 Jun 30.
The prevalence of asthma and overweight/obesity in children and adolescents is continuously increasing over the last decades. It remains unclear if overweight/obesity raises the risk of developing asthma or if an uncontrolled asthma increases the risk of developing overweight/obesity by restricting physical activity.
We aimed to elucidate, if children and adolescents with overweight/obesity differ from normal-weight asthmatics in lung functions parameters (FEV1, FEV1/VC, MEF50 and SRtot) and in exhaled nitric oxide (FeNO).
Totally, n=142 children and adolescents aged 6-18 years were included in this study: group 1 comprised n=44 with overweight/obesity defined as a Body-Mass-Index (BMI)>90th percentile; group 2 n=44 with a doctors diagnosed bronchial asthma according to the GINA-guidelines, and group 3 with n=36 pulmonary healthy controls. N=18 children with both asthma and overweight/obesity were excluded from further analysis. We collected data about socio-demographic variables from a standardized questionnaire, bodyplethysmography (FEV1, FEV1/VC, MEF50 and SRtot) and FeNO.
Normal-weight children and adolescents with asthma had significantly lower FEV1/VC (Tiffenau-Index 90,9±12,8) and MEF50 (84.0% predicted±27.6) than children with overweight/obesity (97,6±12,4 p=0.001 respectively 99.1±20.9 p=0.001) and healthy controls (98±13,5 p=0,003; 96.7±19.3 p=0.011). Normal weight asthmatics had a significantly higher FeNO (38.3 ppb) than children and adolescents with overweight/obesity (14.0 ppb p=0.014).
Normal-weight children and adolescents with asthma differ significantly both in their lung function parameters as well as in their exhaled nitric oxide concentration from children and adolescents with overweight/obesity. For clinical practice it is important to note that children and adolescents with overweight/obesity have no signs of an obstructive airway diseases and are as resilient as healthy children and adolescents with regard to their lung function. The possible late-onset of asthma symptoms and lung function changes in children and adolescents with overweight/obesity requires further detailed longitudinal studies.
在过去几十年中，儿童和青少年哮喘以及超重/肥胖的患病率持续上升。目前尚不清楚超重/肥胖是否会增加患哮喘的风险，或者未得到控制的哮喘是否会通过限制身体活动而增加患超重/肥胖的风险。
我们旨在阐明超重/肥胖的儿童和青少年在肺功能参数（第一秒用力呼气容积[FEV1]、FEV1/用力肺活量[VC]、50%最大呼气流量[MEF50]和总比气道传导率[SRtot]）以及呼出一氧化氮（FeNO）方面是否与正常体重的哮喘患者存在差异。
本研究共纳入142名6至18岁的儿童和青少年：第1组包括44名超重/肥胖者，定义为体重指数（BMI）>第90百分位数；第2组有44名根据全球哮喘防治创议（GINA）指南被医生诊断为支气管哮喘的患者，第3组有36名肺部健康对照者。18名同时患有哮喘和超重/肥胖的儿童被排除在进一步分析之外。我们通过标准化问卷收集了社会人口统计学变量、体容积描记法（FEV1、FEV1/VC、MEF50和SRtot）以及FeNO的数据。
正常体重的哮喘儿童和青少年的FEV1/VC（蒂芬诺指数90.9±12.8）和MEF50（预测值的84.0%±27.6）显著低于超重/肥胖儿童（分别为97.6±12.4，p = 0.001；99.1±20.9，p = 0.001）和健康对照者（98±13.5，p = 0.003；96.7±19.3，p = 0.011）。正常体重的哮喘患者的FeNO（38.3 ppb）显著高于超重/肥胖的儿童和青少年（14.0 ppb，p = 0.014）。
正常体重的哮喘儿童和青少年在肺功能参数以及呼出一氧化氮浓度方面与超重/肥胖的儿童和青少年存在显著差异。对于临床实践而言，需要注意的是超重/肥胖的儿童和青少年没有阻塞性气道疾病的迹象，并且在肺功能方面与健康的儿童和青少年一样有弹性。超重/肥胖的儿童和青少年哮喘症状及肺功能变化可能出现较晚，这需要进一步详细的纵向研究。
