Associations between body weight, asthma burden, and T2 inflammation among under-resourced children.

Background: Overweight/obesity is a risk factor for asthma, particularly in under-resourced children, and contributes to higher disease burden. T2 inflammation, a key characteristic of asthma endotypes, has been inconsistently associated with burden of obesity-related asthma, which may be due to limited overlap between different T2 features, including elevated total serum IgE, eosinophilia, and allergen sensitization.

Objective: To investigate the effects of different T2 features on association of overweight/obesity with asthma burden in under-resourced children.

Methods: Among 2,160 children ages 6-20 years from four Inner-City Asthma Consortium cohorts, we investigated the association of overweight/obesity with asthma burden (unscheduled visits, hospitalizations, exacerbations, asthma control, and pulmonary function), and the effect of T2 features (total IgE higher than age-specific cutoffs, total eosinophils >300 cells/ul, or sensitization to ≥2 allergens) on the association.

Results: The odds (OR (95% CI)) of unscheduled visits was higher among those with overweight/obesity (1.35 (1.04-1.75)) and allergen sensitization (1.35 (1.02-1.80)), hospitalizations was higher among those with elevated total IgE (2.17 (1.27-3.69)) and eosinophilia (2.80 (1.56-5.21)), and poor asthma control was higher among those with elevated total IgE (1.27 (1.09-1.41)). Overweight/obesity and all T2 features were associated with lower FEV1/FVC ratio. There was no synergistic or clinically significant mediating influence of any of T2 features on the association of overweight/obesity with asthma burden.

Conclusion: Among under-resourced children with asthma, overweight/obesity and T2 inflammation are largely independently associated with unscheduled visits and pulmonary function deficits. T2 inflammation, but not overweight/obesity, is associated with poor control and hospitalizations.