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

Background Obese children for unknown reasons report greater asthma symptoms. Asthma and obesity both independently associate with gastro-oesophageal re fl ux 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 signi fi cantly worse asthma control (Asthma Control Questionnaire, p=0.007). A signi fi cant but weaker association between GORS and asthma symptoms was seen in leans compared with obese in the replicate cohort.

背景儿童出于未知的原因报告了哮喘症状，肥胖是独立于胃 - 植物学症状（GORS）我们以前的工作确定了GOR和哮喘表型之间的关联程度。 （20％ - 65％的体重指数，BMI）和肥胖（≥95％的BMI）10 - 17岁的儿童持续，早期发作的哮喘使用多变量线性和逻辑回归的重量状态，GOR和哮喘结局之间的关联肥胖儿童报告多个GOR的几倍（OR = 7.7，95％CI 1.9至31.0，相互作用P值= .004）与肥胖患者的GORS分数密切相关（r = 0.815，P <0.0001 ），但不在倾斜中（r = 0.291，p = 0.200；相互作用p值= 0.003）。 （R10，p = 0.025），改善气道电抗（X10，p = 0.005），但哮喘控制次数较差（哮喘控制问卷，p = 0.007）。与重复队列中的肥胖相比。