Gastro-oesophageal reflux and worse asthma control in obese children: a case of symptom misattribution?

Journal Article (Journal Article)

BACKGROUND: Obese children for unknown reasons report greater asthma symptoms. Asthma and obesity both independently associate with gastro-oesophageal reflux symptoms (GORS). Determining if obesity affects the link between GORS and asthma will help elucidate the obese-asthma phenotype. OBJECTIVE: Extend our previous work to determine the degree of associations between the GORS and asthma phenotype. METHODS: We conducted a cross-sectional study of lean (20%-65% body mass index, BMI) and obese (≥95% BMI) children aged 10-17 years old with persistent, early-onset asthma. Participants contributed demographics, GORS and asthma questionnaires and lung function data. We determined associations between weight status, GORS and asthma outcomes using multivariable linear and logistic regression. Findings were replicated in a second well-characterised cohort of asthmatic children. RESULTS: Obese children had seven times higher odds of reporting multiple GORS (OR=7.7, 95% CI 1.9 to 31.0, interaction p value=.004). Asthma symptoms were closely associated with GORS scores in obese patients (r=0.815, p<0.0001) but not in leans (r=0.291, p=0.200; interaction p value=0.003). Higher GORS scores associated with higher FEV1-per cent predicted (p=0.003), lower airway resistance (R10, p=0.025), improved airway reactance (X10, p=0.005) but significantly worse asthma control (Asthma Control Questionnaire, p=0.007). A significant but weaker association between GORS and asthma symptoms was seen in leans compared with obese in the replicate cohort. CONCLUSION: GORS are more likely to associate with asthma symptoms in obese children. Better lung function among children reporting gastro-oesophageal reflux and asthma symptoms suggests that misattribution of GORS to asthma may be a contributing mechanism to excess asthma symptoms in obese children.

Full Text

Duke Authors

Cited Authors

  • Lang, JE; Hossain, J; Holbrook, JT; Teague, WG; Gold, BD; Wise, RA; Lima, JJ

Published Date

  • March 2016

Published In

Volume / Issue

  • 71 / 3

Start / End Page

  • 238 - 246

PubMed ID

  • 26834184

Pubmed Central ID

  • PMC9169159

Electronic International Standard Serial Number (EISSN)

  • 1468-3296

Digital Object Identifier (DOI)

  • 10.1136/thoraxjnl-2015-207662


  • eng

Conference Location

  • England