Інформація призначена тільки для фахівців сфери охорони здоров'я, осіб,
які мають вищу або середню спеціальну медичну освіту.


Підтвердіть, що Ви є фахівцем у сфері охорони здоров'я.

"Child`s Health" 8 (68) 2015

Back to issue

Features of Bronchial Asthma in Children with Overweight and Obesity

Authors: Volosovets О.P., Kryvopustov S.P., Makukha M.T., Kupkina A.V. - National Medical University named after O.O. Bohomolets, Kyiv; Kyiv Municipal Children’s Clinical Hospital № 2, Kyiv, Ukraine

Categories: Pediatrics/Neonatology

Sections: Specialist manual

print version


Summary

У статті розглянуто питання коморбідності бронхіальної астми у дітей із надмірною масою тіла та ожирінням. Описано основні патогенетичні механізми взаємозв’язку бронхіальної астми з надмірною масою тіла та ожирінням. Акцентовано увагу на ролі нейтрофільного запалення у патогенезі бронхіальної астми в таких пацієнтів.

В статье рассмотрены вопросы коморбидности бронхиальной астмы у детей с избыточной массой тела и ожирением. Описаны основные патогенетические механизмы взаимосвязи бронхиальной астмы с избыточной массой тела и ожирением. Акцентировано внимание на роли нейтрофильного воспаления в патогенезе бронхиальной астмы у таких пациентов.

The article deals with the problem of comorbi­dity of bronchial asthma in children with overweight and obesity. The basic pathogenetic mechanisms of correlation between bronchial asthma and overweight and obesity are described. The attention is focused on the role of neutrophilic inflammation in the pathogenesis of bronchial asthma in these patients.


Keywords

бронхіальна астма, ожиріння, діти.

бронхиальная астма, ожирение, дети.

bronchial asthma, obesity, children.

There is a steady increase of bronchial asthma (BA) in the world, including for child population. Today, according to WHO 300 million people worldwide suffer from BA, and by 2025 the WHO has predicted 600 million patients. In addition to inadequate treatment, the causes of inadequate asthma control include: environmental issues, the using of large amounts of chemicals in the home, often uncontrollable drug intake, severe asthma, which is often associated with severe inflammation;  chronic exposure to sensitizing unaccounted factors and comorbidities. Particularly noteworthy are comorbidities,  which are having common or similar etiological and pathogenetic factors,  such as combination of BA and obesity.

Child obesity is a new global health challenge through its tendensy to growth in this age group and health outcomes in later life.  Both processes BA and obesity are chronic, complex and multifactorial in nature. Being overweight increases 2 times (and obesity increases 2.7 times) the risk of airway hyperresponsiveness, regardless of age or gender. The combination of BA  and obesity creates a "vicious circle" in the course of these diseases. As noted Gina, 2015  materials, overweight status appears to increase asthma risk.

The combination of these two pathologies is determined by a number of scientists as a single phenotype or endofenotype of BA. The current of this phenotype of  BA is more severe, it has more frequent exacerbations and reduced control of the disease. Some mechanisms by which obesity affects on BA are formulated and described now: systemic inflammation which is associated with obesity (increased levels of circulating cytokines such as IL-6, TNF; the impact of overweight on the mechanics of respiration, oxidative stress, hormones of obesity (leptin, Adiponectin, resistin), common genetic factors, the presence of comorbid conditions such as gastroesophageal reflux disease and sleep apnea.

Excess weight has a negative effect on the function of the respiratory system. The mechanical influence of overweight on the function of the lungs realized by direct pressure of a large mass of subcutaneous fat on the chest, anterior abdominal wall, excess fat deposition on the diaphragm.

Adipose tissue is now considered as an important endocrine organ,  which produces number of adypokines with  pro- and anti-inflammatory effect. In particular, adipose tissue is a source of proinflammatory mediators  such as C-reactive protein, tumor necrosis factor-alpha, eotaksyn, leptin, a protein, transforming growth factor, interleukins 4, 5, 6, 13; plasminogen activator inhibitor-1; protein that stimulates acetylation; free fatty acids; angiotensinogen and others. The balance between pro-inflammatory (leptin, resistin) and antiinflammatory (adiponectin) adypokines plays an important role in combination of BA and obesity, as the imbalance of cytokine production towards proinflammatory may be a factor supporting systemic inflammation. Leptin has a systemic inflammatory effect, which may promote the development of BA. Increased blood leptin may be a marker of more severe obstruction and inflammation at all levels of respiratory tract in patients with BA and overweight. Adiponectin is a fat hormone, which has a positive influence on the metabolism of lipids and carbohydrates. It is an antiinflammatory cytokine. Adiponectin production level decreases in people with obesity and this decreasing causes endothelial damage and the development of systemic chronic inflammation, which complicates the course of BA in people with obesity, increasing its development.

The presence of both episodic bronchial obstruction in BA and constant violation of the external breathing caused by obesity, contribute to the deepening of hypoxia and increasing of the oxidative stress. There is a hypothesis that oxidative stress in obesity can be caused by hyperglycemia, hiperleptynemia, hyperlipidemia and the presence of chronic inflammation. This process is accompanied by increased production of reactive oxygen and it promotes the activity of lipid peroxidation and it causes reduced activity of anti-oxidant protection.

Obesity is also associated with underlying medical conditions such as gastroesophageal reflux disease syndrome and obstructive sleep apnea/hypopnea, each of them aggravates BA.

Another of pathogenic components of this combined states is genetic factor. Identified regions in the genome that may contain genes that lead to the formation of both pathological conditions: 5q23-32, 6p21-23, 11q13, and 12q13-24.

It is possible that one or more of the above simultaneously (or not yet reveal) mechanisms of pathogenesis common to BA and obesity can influence to increase the risk of BA.

The influence of weight loss on the course of asthma among adults was determined by a significant improvement in the respiratory tract on lung volumes, asthma symptoms, exercise tolerance due to weight reduction; and although the question of the impact of weight loss in obese children with BA has not been studied enough, we should expect similar improvements to quality of life.

Thus, the features of BA in children with overweight and obesity require a general understanding of the mechanisms underlying the pathogenesis of obesity and BA, and of course, there are major elements in the development of new therapeutic strategies.


Bibliography

1. Альошина А.І. Особливості застосування лікувальної фізичної культури для дітей, хворих на бронхіальну астму / А.І. Альошина // Педагогіка, психологія та медико-біологічні проблеми фізичного виховання і спорту. — 2012. — № 6. — С. 12-15.

2. Величко В.І. Бронхіальна астма, ожиріння та гастроезофагеальна рефлюксна хвороба: можливі механізми взаємозв’язку / В.І. Величко, Я.І. Венгер, О.М. Платонова // Одеський медичний журнал. — 2013. — № 3(137). — С. 57-62.

3. Клинические фенотипы бронхиальной астмы у подростков: трудности диагностики и терапии / [Астафьева Н.Г., И.В. Гамова, Е.Н. Удовиченко и др.] // Лечащий врач. — 2015. — № 4, 6, 8.

4. Минеев В.Н. Бронхиальная астма и ожирение: общие механизмы / В.Н. Минеев, Т.М. Лалаева, В.И.Трофимов // Клиническая медицина. — 2012. — № 4. — С. 4-10.

5. Мокина Н.А. Клинико-диагностическая оценка лептина крови при атопической бронхиальной астме у подростков с избыточной массой тела / Н.А. Мокина, Е.В. Вершинина, В.А. Ревякина // Вопросы практической педиатрии. — 2012. — № 6. — С. 24-29.

6. Перцева Т.А. Астма и ожирение: какова взаимосвязь? / Т.А. Перцева, Н.П. Нудьга // Український пульмонологічний журнал. — 2011. — № 1. — С. 61-64.

7. Победенная Г.П. К вопросу о коморбидной патологии: бронхиальная астма и ожирение / Г.П. Победенная, С.В. Ярцева // Астма та алергія. — 2014. — № 2. — С. 54-61.

8. Приступа Л.Н. Бронхіальна астма та метаболічний синдром: монографія / Л.Н. Приступа, Г.А. Фадєєва. — Суми: Сумський державний університет, 2014. — 239 с.

9. Радченко О.М. Фенотип бронхіальної астми з ожирінням / О.М. Радченко, О.Р. Слаба // Астма та алергія. — 2014. — № 2. — С. 19-21.

10. Фадєєва Г.А. Гіперлептинемія як посередник між ожирінням і бронхіальною астмою / Г.А. Фадєєва, Л.Н. Приступа // Астма і алергія. — 2008. — № 1–2. — С. 5-10.

11. Фещенко Ю.И. Особенности бронхиальной астмы у больных с метаболическим синдромом / Ю.И. Фещенко, Л.А. Яшина, С.Г. Опимах // Здоров’я України. — 2014. — № 9(334) — С. 27-29.

12. Цибулькина В.Н. Бронхиальная астма и ожирение: совпадение или закономерность? / В.Н. Цибулькина, Н.А. Цибулькин // Практическая медицина. Акушерство. Гинекология. Эндокринология. — 2011. — № 6(54). — С. 36-41.

13. Юдина Л.В. Недостаточный контроль бронхиальной астмы. В чем причина? / Л.В. Юдина, Ю.В. Рачко // Новости медицины и фармации. — 2010. — № 4(309). — С. 25-32.

14. Яшина Л.А. Бронхиальная астма у больных с ожирением — особый фенотип заболевания / Л.А. Яшина, С.Г. Ищук // Астма та алергія. — 2011. — № 4. — С. 46-49.

15. Bronchial asthma in obesity — a distinct phenotype of asthma?/ D. Ziora, P. Sitek, E. Machura, K. Ziora // Pneumonologia i alergologia polska. — 2012. — Vol. 80(5). — P. 454-462. [http://www.ncbi.nlm.nih.gov/pubmed/22926907]

16. Delgado J. Obesity and Asthma/ J. Delgado, P. Barranco, S.Quirce // Journal of investigational allergology & Сlinical immunology. — 2008. — Vol. 18(6). — P. 420-425. [http://www.ncbi.nlm.nih.gov/pubmed/19123432]

17. Dixon A.E. Obesity: changing asthma in the 21st century / A.E. Dixon // American journal of respiratory and critical care medicine. — 2012. — Vol. 186 (5). — P. 395-396. DOI: 10.1164/rccm.201206-1092ED.

18. Do mast cells link obesity and asthma? / N. Sismanopoulos, D.-A. Delivanis, D. Mavrommati [et al.] // Allergy. — 2013. — Vol. 68(1). — P. 8-15. DOI: 10.1111/all.12043.

19. Forno E. Obesity and Asthma: comorbid and coexisting / E. Forno, L.P. Boulet, J.C. Celedon // Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis. — Oxford University Press, 2014. — P. 321-323.

20. Global Initiative for Asthma (GINA). Pocket guide for asthma management and prevention (for Adults and Children Older than 5 Years), 2015. — 28 p. http://www.ginasthma.org/documents/1/Pocket-Guide-for-Asthma-Management-and-Prevention.

21. Green T.L. Examining the temporal relationships between childhood obesity and asthma/ T.L. Green// Economics and human biology. — 2014. — Vol. 14. — P. 92-102. DOI: 10.1016/j.ehb.2012.10.002.

22. Influence of asthma definition on the asthma-obesity relationship / A.A. Cetlin, M.R. Gutierrez, H. Bettiol [et al.] // BMC Public Health. — 2012. — Vol. 12. — P. 844. DOI: 10.1186/1471-2458-12-844.

23. Kajbaf T.Z. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study / T.Z. Kaj–baf, S. Asar, M.R. Alipoor // Italian Journal of Pediatrics. — 2011. — № 37. — P. 1-5. DOI: 10.1186/1824-7288-37-1.

24. Kryštofová J. Bronchial asthma and obesity in childhood / J. Kryštofová, M. Jeseňák, P. Bánovčin // Acta medica (Hradec Králové). — 2011. — № 54(3). — P. 102-106.

25. Lang J.E. Overweight children report qualitatively distinct asthma symptoms: Analysis of validated symptom measures / J.E. Lang, J. Hossain, J.J. Lima // The Journal of allergy and clinical immunology. — 2015. — Vol. 135(4). — P. 886-893. DOI: 10.1016/j.jaci.2014.08.029.

26. Lee H.J. Genetic interactions model among Eotaxin gene polymorphisms in asthma / H.J. Lee, J.H. Moore, S. Park // Journal of Human Genetics. — 2008. — Vol. 53(10). — P. 867-875.

27. Leptin and adiponectin are valuable serum markers explai–ning obesity/bronchial asthma interrelationship / A. Salah, M. Ragab, W. Mansour, M. Taher // Egyptian journal of chest diseases and tuberculosis. — 2015. — Vol. 64(3). — P. 529-533. DOI: 10.1016/j.ejcdt.2015.02.012.

28. Litonjua A.A. Asthma and obesity: common early-life influences in the inception of disease/ A.A. Litonjua, D.R. Gold // The Journal of allergy and clinical immunology. — 2008. — Vol. 121(5). — P. 1075-1086. DOI: 10.1016/j.jaci.2008.03.005. 

29. Lugogo N.L. Does obesity produce a distinct asthma phenotype/ N.L. Lugogo, M. Kraft, A.E. Dixon // Journal of applied physiology. — 2010. — Vol. 108(3). — P. 729-734. DOI: 10.1152/japplphysiol.00845.2009.

30. Lumeng C.N. Inflammatory links between obesity and metabolic disease / C.N. Lumeng, A.R. Saltiel // The Journal of clinical investigation. — 2011. — Vol. 121(6). — P. 2111-2117. DOI: 10.1172/JCI57132.

31. No association between overweight and asthma or allergy in adolescence after wheezing in infancy / M. Ruotsalainen, M.K. Hyvärinen, A. Saari [et al.] // Acta Paediatrica. — 2013. — Vol. 102(2). — P. 167-171. DOI: 10.1111/apa.12082.

32. Oxidant mechanisms in childhood obesity: the link between inflammation and oxidtative sress / P. Codoñer-Franch, V. Valls-Bellés, A. Arilla-Codoñer, E. Alonso-Iglesias // Translational research: the journal of laboratory and clinical medicine. — 2011. — Vol. 158(6). — P. 369-384. DOI: 10.1016/j.trsl.2011.08.004.

33. PRKCA: a positional candidate gene for body mass index and asthma / A. Murphy, K.G. Tantisira, M.E. Soto-Quiros [et al.] // American Journal of Human Genetics. — 2009. — Vol. 85(1). — P. 87-96. DOI: 10.1016/j.ajhg.2009.06.011.

34. Procaccini C.L. Leptin as an immunomodulator / C. Procaccini, E. Jirillo, G. Matarese // Molecular aspects of medicine. — 2012. — Vol. 33(1). — P. 35-45. DOI: 10.1016/j.mam.2011.10.012.

35. Risk of an asthma exacerbation after bariatric surgery in adults / K. Hasegawa, Y. Tsugawa, Y. Chang, C.A. Camargo // The Journal of allergy and clinical immunology. — 2015. — Vol. 136(2). — P. 288-294. DOI: 10.1016/j.jaci.2014.12.1931.

36. Role of obesity in asthma control, the obesity-asthma phenotype / S. Novosad, S. Khan, B. Wolfe, A. Khan // Journal of Allergy (Cairo) [electronic resource]. — 2013. DOI: 10.1155/2013/538642. 

37. Shore S.A. Obesity and asthma: location, location, location / S.A. Shore // The European respiratory journal. — 2013. — Vol. 41(2). — P. 253-254. DOI: 10.1183/09031936.00128812.

38. Stream A.R. Obesity and asthma disease phenotypes / A.R. Stream, E.R. Sutherland // Current opinion in allergy and clinical immunology. — 2012. — Vol. 12(1). — P. 76-81. DOI: 10.1097/ACI.0b013e32834eca41.

39. The influence of leptin on Th1/Th2 balance in obese children with asthma / D.M. Youssef, R.M. Elbehidy, D.M. Shokry, E.M. Elbehidy // Jornal brasileiro de pneumologia. — 2013. — Vol. 39(5). — P. 562-568. DOI: 10.1590/S1806-37132013000500006.

40. Vortmann M. BMI and health status among adults with asthma / M. Vortmann, M.D. Eisner // Obesity (Silver Spring). — 2008. — Vol. 16(1). — P. 146-152. DOI: 10.1038/oby.2007.7.


1. Aleshina AI. [Features of the application of medical physical training for children with asthma]. Pedahohika, psykholohiya ta medyko-biolohichni problemy fizychnoho vykhovannya i sportu. 2012; 6:12-15. Ukrainian.

2. Velychko VI, Venger YaI, Platonova OM. [Bronchial asthma, obesity and gastroesophageal reflux disease: possible mechanisms of interrelation].  Odes'kyy medychnyy zhurnal. 2013; 3( 137): 57-62. Ukrainian.

3. Astaf’eva NH, Hamova YV, Udovychenko EN, Perfylova YA, Mykhaylova YE, Naumova OS. [Clinical phenotypes of bronchial asthma in teenagers, difficulties of the diagnostics and therapy].  Lechashchyy vrach. 2015; 4,6,8. Russian.

4. Myneev VN, Lalaeva TM, Trofymov VY. [Bronchial asthma and obesity: common mechanisms]. Klynycheskaya medytsyna. 2012;  4:4-10. Russian.

5. Mokyna NA, Vershynyna EV,  Revyakyna VA. [Clinical diagnostic evaluation of blood leptin with atopic asthma in adolescents with overweight]. Voprosy praktycheskoy pedyatryy. 2012; 6:24-29. Russian.

6. Pertseva TA, Nud'ha NP. [Asthma and obesity: what is the relationship?]. Ukrayins'kyy pul'monolohichnyy zhurnal. 2011; 1:61-64. Russian.

7. Pobedyonnaya HP, Yartseva SV. [To the question of comorbidity: asthma and obesity]. Astma ta alerhiya. 2014; 2:54- 61. Russian.

8. Prystupa LN, Fadyeyeva HA. Bronkhial'na astma ta metabolichnyy syndrom [Bronchial asthma and metabolic syndrome]. - Sumy: Sums'kyy derzhavnyy universytet; 2014. 239p. Ukrainian.

9. Radchenko OM, Slaba OR. [The phenotype of asthma with obesity]. Astma ta alerhiya. 2014; 2:19-21. Ukrainian.

10. Fadyeyeva HA, Prystupa LN. [Hiperleptynemia as an intermediary between obesity and asthma]. Astma i alerhiya. 2008; 1-2:5-10. Ukrainian.

11. Feshchenko YuY,Yashyna LA, Opymakh  SH. [Features of bronchial asthma in patients with metabolic syndrome]. Zdorov"ya Ukrayiny. 2014; 9(334):27- 29. Russian.

12. Tsybul'kyna VN, Tsybul'kyn NA. [Asthma and obesity: a coincidence or pattern?]. Praktycheskaya medytsyna. Akusherstvo. Hynekolohyya. Endokrynolohyya. 2011; 6(54):36-41. Russian.

13. Yudyna LV, Rachko YuV. [Inadequate control of asthma. What is the reason?]. Novosty medytsyny y farmatsyy.  2010; 4 (309): 25-32. Russian.

14. Yashyna LA, Yshchuk SH. [Bronchial asthma in obese patients - a particular disease phenotype].  Astma ta alerhiya.  2011; 4:46-49. Russian.

15. Ziora D, Sitek P, Machura E, Ziora K. [Bronchial asthma in obesity - a distinct phenotype of asthma?]. Pneumonologia i alergologia polska. 2012; 80(5):454–462. Polish. PMID22926907.

16. Delgado J, Barranco P, Quirce S. Obesity and Asthma.  Journal of investigational allergology & clinical immunology. 2008; 18(6):420-425.

17. Dixon AE. Obesity: changing asthma in the 21st century. American journal of respiratory and critical care medicine. 2012; 186(5):395-396. DOI:10.1164/rccm.201206-1092ED.

18. Sismanopoulos N, Delivanis D-A, Mavrommati D,  Hatziagelaki E, Conti P, Theoharides TC. Do mast cells link obesity and asthma? Allergy. 2013; 68(1):8–15. DOI:10.1111/all.12043.

19. Forno E, Boulet LP, Celedon JC. Obesity and Asthma: comorbid and coexisting. In: Lockey RF, Ledford DK, eds, in collaboration with the World Allergy Organization. Asthma: Comorbidities, Coexisting Conditions, and Differential Diagnosis. Oxford: Oxford University Press; 2014: 321-323.

20. Global Initiative for Asthma (GINA). Pocket guide for asthma management and prevention (for Adults and Children Older than 5 Years), 2015. – 28 p. http://www.ginasthma.org/documents/1/Pocket-Guide-for-Asthma-Management-and-Prevention.

21. Green TL. Examining the temporal relationships between childhood obesity and asthma. Economics and human biology. 2014; 14:92–102.  DOI:10.1016/j.ehb.2012.10.002.

22. Cetlin AA, Gutierrez MR, Bettiol H, Barbieri M,Vianna EO. Influence of asthma definition on the asthma-obesity relationship. BMC Public Health. 2012; 12:844. DOI:10.1186/1471-2458-12-844.

23.  Kajbaf TZ, Asar S, Alipoor MR. Relationship between obesity and asthma symptoms among children in Ahvaz, Iran: a cross sectional study. Italian Journal of Pediatrics. 2011; 37:1-5.  DOI:10.1186/1824-7288-37-1.

24.Kryštofová J, Jeseňák M, Bánovčin P. Bronchial asthma and obesity in childhood. Acta medica (Hradec Králové). 2011; 54(3):102–106.

25. Lang JE, Hossain J, Lima JJ. Overweight children report qualitatively distinct asthma symptoms: Analysis of validated symptom measures. Journal of Allergy and Clinical Immunology. 2015; 135(4):886-893. DOI:10.1016/j.jaci.2014.08.029.

26. Lee JH, Moore JH, Park SW, Jang AS, Uh ST, Kim YH, Park CS, Park BL, Shin HD. Genetic interactions model among Eotaxin gene polymorphisms in asthma. J Hum Genet. 2008; 53(10):867–875. DOI:10.1007/s10038-008-0314-y.

27. Salah A, Ragab M, Mansour W, Taher M. Leptin and adiponectin are valuable serum markers explaining obesity/bronchial asthma interrelationship. Egyptian Journal of Chest Diseases and Tuberculosis. 2015; 64(3):529–533. DOI:10.1016/j.ejcdt.2015.02.012.

28. Litonjua AA. Gold DR. Asthma and obesity: common early-life influences in the inception of disease. J Allergy Clin Immunol. 2008; 121(5):1075–1086. DOI:10.1016/j.jaci.2008.03.005.

29. Lugogo NL, Kraft M, Dixon AE. Does obesity produce a distinct asthma phenotype.  Journal of applied physiology. 2010; 108(3):729–734. DOI:10.1152/japplphysiol.00845.2009.

30. Lumeng CN, Saltiel AR. Inflammatory links between obesity and metabolic disease. J. Clin. Invest. 2011; 121(6):2111–2117. DOI:10.1172/JCI57132.

31. Ruotsalainen M, Hyvärinen MK, Saari A, Piippo-Savolainen E, Korppi M. No association between overweight and asthma or allergy in adolescence after wheezing in infancy. Acta Paediatrica. 2013; 102(2):167-171. DOI:10.1111/apa.12082.

32. Codoñer-Franch P, Valls-Bellés V, Arilla-Codoñer A, Alonso-Iglesias E.Oxidant mechanisms in childhood obesity: the link between inflammation and oxidtative sress. Transl Res. 2011; 158(6):369-84. DOI:10.1016/j.trsl.2011.08.004.

33. Murphy A, Tantisira KG, Soto-Quirós ME, Avila L, Klanderman BJ, Lake S, Weiss ST, Celedón JC. PRKCA: a positional candidate gene for body mass index and asthma. Am J Hum Genet. 2009; 85(1):87-96. DOI:10.1016/j.ajhg.2009.06.011.

34. Procaccini C, Jirillo E, Matarese G. Leptin as an immunomodulator. Mol Aspects Med. 2012; 33(1):35-45. DOI:10.1016/j.mam.2011.10.012.

35. Hasegawa K, Tsugawa Y, Chang Y, Camargo CA . Risk of an asthma exacerbation after bariatric surgery in adults. J Allergy Clin Immunol. 2015; 136(2):288-94. DOI:10.1016/j.jaci.2014.12.1931.

36. Novosad S, Khan S, Wolfe B, Khan A. Role of obesity in asthma control, the obesity-asthma phenotype. J Allergy (Cairo). 2013; Article ID 538642, 9 pages. DOI:10.1155/2013/538642. 
37. Shore SA. Obesity and asthma: location, location, location. Eur Respir J. 2013; 41(2):253-254. DOI:10.1183/09031936.00128812.

38. Stream AR, Sutherland ER. Obesity and asthma disease phenotypes. Curr Opin Allergy Clin Immunol. 2012; 12(1):76-81. DOI: 10.1097/ACI.0b013e32834eca41.

39. Youssef DM, Elbehidy RM, Shokry DM, Elbehidy EM.The influence of leptin on Th1/Th2 balance in obese children with asthma. J Bras Pneumol. 2013;39(5):562-568. doi: 10.1590/S1806-37132013000500006. PMID: 2431062940.

40. Vortmann M, Eisner MD. BMI and health status among adults with asthma . Obesity (Silver Spring). 2008;16(1):146-152. doi: 10.1038/oby.2007.7. PMID: 18223627.

Similar articles

Features of the treatment of bronchial asthma  in children with overweight and obesity
Authors: Волосовець О.П., Кривопустов С.П., Купкіна А.В.
Національний медичний університет імені О.О. Богомольця, м. Київ, Україна

"Child`s Health" Том 12, №1, 2017
Date: 2017.03.29
Categories: Pediatrics/Neonatology
Sections: Specialist manual
Features of Cellular Link of Immune Response in School-Age Children with Late-Onset Asthma Depending on Acetylation Polymorphism
Authors: Marusyk U.I. - Higher Education Institution of Ukraine «Bukovinian State Medical University», Chernivtsi; Bezrukov I.U. - Regional Children Clinical Hospital, Chernivtsi, Ukraine
"Child`s Health" 2 (70) 2016
Date: 2016.05.17
Categories: Pediatrics/Neonatology
Sections: Clinical researches
Features of Cytological Profile of Induced Sputum in School-Age Children with Exercise-Induced Bronchial Asthma
Authors: Bezrukov L.O., Ortemenka Ye.P. - Higher State Educational Institution of Ukraine «Bukovinian State Medical University», Chernivtsi, Ukraine
"Child`s Health" 1 (69) 2016
Date: 2016.04.13
Categories: Pediatrics/Neonatology
Sections: Clinical researches

Back to issue