Metabolic dysfunction and lung disease: children are no small adults

Not only in adults but also in the paediatric population obesity is detrimental to respiratory health. Many things are similar to the adult population, including underlying immune mechanisms and inflammatory pathways. But there are also striking differences, especially regarding the anatomy and the development [1].

The extra weight compresses the lung and reduces lung volume and airway diameter. Therefore, it gets more difficult for the airway muscles to relax. Nevertheless, lung function in adults remains the same across a wide BMI spectrum [2]. “However, this is not the case in children; in obese children, FEV₁ decreases rapidly,” Prof. Erick Forno (University of Pittsburgh, PA, USA) explained. Another significant difference is airway dysanapsis, the incongruence or asymmetry between the growth of the lung volumes and the calibre of the airways.

“In older adults starting in their 30s and up to their 70s, a restriction is observed following obesity-related lung function. This concept is different in children,” Prof. Forno explained. In obese children, airway dysanapsis is present and associated with increased asthma morbidity. The presence of dysanapsis is reflected in greater lung volumes and lesser flows and may partly explain their reduced response to inhaled corticosteroids [3].

In a systematic review, randomised controlled trials that included paediatric asthma patients were analysed [4]. Altogether, 4 trials with a total of 246 patients could be analysed. In these trials, weight loss led to improvements in asthma-related quality of life and, to some degree, asthma control [4]. “Weight loss is important in children. Although we only have small studies, improvements are certainly visible,” Prof. Forno concluded.

1. Forno E. Metabolic dysregulation and lung disease: are children small adults? Session A026: Metabolic dysregulation and lung disease: a common thread between children and adults. ATS 2021 International Conference, 14-19 May.
2. Forno E, et al. J Allergy Clin Immunol Pract 2018;6(2):570-81.
3. Forno E, et al. Am J Respir Crit Care Med 2017;195(3):31-23.
4. Okoniewski W, et al. Ann Am Thorac Soc 2019;16(5):613-25.

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Posted on 5 July 2021