The relationship between body mass index, asthma symptom report, ethnicity, and asthma-related outcomes in childhood asthma

Abstract

Objective: High Body Mass Index (BMI) has been shown to be associated with increased health care utilization, worsening of asthma symptoms and poor asthma control among children with asthma. The present study hypothesized that children who are overweight or obese, would report higher frequency of healthcare utilization including oral steroid bursts and report more asthma symptoms than normal weight children in a sample of Puerto Rican and Mexican children with asthma. Additionally, the study hypothesized there will be an interaction effect between BMI, ethnicity and asthma control in that overweight/ obese Puerto Rican children would have worse asthma control compared to overweight/obese Mexican children. Methods: 260 Mexican and Puerto Rican children between ages 5 and 12 with physician-diagnosed asthma and their caregivers were recruited from Phoenix. Arizona and the Bronx, New York. Questionnaires were administered to both children and their caregivers at baseline. Asthma control was measured by using the validated Childhood Asthma Control Test (C-ACT) and Asthma Control Test (ACT) while asthma morbidity was measured by examining reported and medical record data on oral steroid bursts, acute healthcare utilization, and hospitalizations n the past 12 months. Parental and child report of asthma symptoms were assessed using the Parent Childhood Asthma Symptom Checklist (P-CASCL) and Childhood Asthma Symptom Checklist (CASCL). Body mass index was calculated as mass in pounds divided by height in inches, compared to sex-specific BMI-for-age percentile. Chi-square tests, analysis of variance (ANOVA), and logistic regression models were fitted to examine the relationship between BMI weight status and asthma-related outcomes. Results: No significant relationships were found between BMI and oral steroid bursts, x2(1, N=260) =2.42, p=.30, acute healthcare utilization, x2 (1, N=260) =1.91./2—.39, or hospitalizations x2 (1, N-260) =3.76, p=.15. BMI status was not significantly associated with children's subjective report of asthma symptoms including panic-fear, F (2, 256) =.62, p=.54, irritability, F (2, 256) =2.04,p=.13, and physical symptoms, F (2, 256) =1.33,p=.27. Child's BMI status was not significantly associated with parent's subjective report of their children's asthma symptoms in either of the three dimensions: panic-fear, F (2, 257) =.1l, p=.90, physical symptoms, F (2, 257) =.28, p=.76, and irritability, F (2, 257) =.75, p=.47. No significant relationship was found between children's asthma control scores and BMI status, x2 (1, N=260) —.69,7—.71. Lastly. no significant interaction was present between ethnicity and BMI group status on asthma control. There was a significant association between ethnicity and asthma control in that Puerto Rican children had worse asthma control compared to Mexican children. Puerto Rican children were more likely to have oral steroid bursts (OR= .38. 95% CI: .19-.75.p =.01) and hospitalizations (OR= .36, 95% CI: .17-.76,p=.01) than Mexican children. Children with moderate or severe persistent asthma were more likely to have oral steroid bursts (OR= .49, 95% CI: .25-.97,p=.04), and report going to the clinic, urgent care, or emergency room in the past 12 months (OR= .46, 95% CI: .26-.80,p =.01) than children with intermittent or mild persistent asthma. Males were more likely to have oral steroids bursts compared to females (OR= 2.30, 95% CI: 1.07- 4.95,p=.03). Conclusions: BMI weight status may not be a barrier for childhood asthma management, but other demographic characteristics such as ethnicity should be considered when looking at asthma outcomes in children.