The Impact of Body Mass Index on Asthma Attacks Severity in Children with Asthma

Background: Obesity is a major concern that increases children's asthma risk. Obese asthmatic patients have more severe symptoms and attacks and less responsiveness to medication. Objectives: We aimed to investigate whether obese children have more asthma attacks, severe exacerbations, and respiratory distress. Methods: This cross-sectional study was performed on 149 children diagnosed with asthma attacks at Taleghani Children's Hospital in Gorgan, Iran, in 2018 - 2019. The relationship between body mass index (BMI) and the severity of asthma attacks in pediatric patients was investigated in 2020. The obtained data were analyzed using SPSS-18 software. Fisher's exact test and Spearman's rank correlation coefficient were used to analyze the data. Results: The mean age of the patients was 8.8 ± 2.76 years; 60.4% were boys, and 39.6% were girls. According to the BMI-age chart, 1.3% of the patients were underweight, 70.5% were in the normal range, 21.5% were overweight, and 6.7% were obese. Patients with higher BMI had more severe asthma attacks (P-value = 0.029) and respiratory distress (P-value = 0.015). In the pulmonary function testing, Forced Vital Capacity (FVC) and Forced Expiratory Volume in the first second (FEV1) were significantly lower in obese children. In addition, pCO2 and HCO3 were higher in overweight patients (P-value = 0.01 and 0.041, respectively). Conclusions: Patients with higher BMI had more severe attacks, exacerbations, and respiratory distress. Also, FVC and FEV1 were significantly lower in obese children. Obesity and asthma have many common pathophysiological mechanisms, and obesity increases the severity of asthma attacks and makes treatment challenging. Different mechanisms are involved in obese patients with asthma, including airway hyperreactivity, inflammation, and airway remodeling. Although the exact relationship between asthma attacks and obesity is still unclear, its understanding could lead to more therapeutic options.