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Does Obesity Increase Respiratory Tract Infections in Patients with Asthma?

BACKGROUND: Since respiratory tract infections (RTIs) precede most exacerbations, better understanding of the risk factors of RTIs and RTI-associated exacerbations in patients with asthma is a pressing public health need. Obesity in patients with asthma is associated with worse asthma control and higher asthma-associated healthcare utilization but its effect on RTI risk is unknown.

OBJECTIVE: We aimed to study the association of BMI classification on the risk of self-reported RTIs and related asthma morbidity among adults and children with asthma.

METHODS: This post-hoc analysis of five large asthma trials involving 747 children and 1287 adults compared BMI classification, defined as lean, overweight and obese based on age-appropriate body mass index (BMI) and BMI-percentile conventions. The primary outcome was rate of visits with RTIs. Secondary asthma outcomes included upper respiratory infection (URI) severity, systemic steroid use, and healthcare contact.

RESULTS: Children had 1.4 times the rate of RTI compared to adults (95% CI 1.27-1.56). In all participants, BMI classification did not affect the rate of visits with RTI. In children, BMI classification did not affect URI severity, all-cause asthma events or RTI-associated asthma events. However, in adults, higher BMI classification was associated with an increase in moderate/severe URI (p=0.02). Adults with higher BMI classification also had increased rates of all-cause and RTI-associated asthma exacerbations requiring systemic steroids and healthcare contact.

CONCLUSIONS: BMI classification was not associated with increased risk of RTIs in children or adults. In adults only, obesity was associated with increased URI severity and all-cause and RTI-associated asthma morbidity.

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