By Dr. Larry Chiaramonte
A recent study by California researchers shows convincing evidence that the epidemics of asthma and obesity are fraternal twins. As reported by Reuters, Dr. Kenneth B. Quinto from the University of California, San Diego, and colleagues examined Kaiser Permanente records for 32,000 asthmatic kids, nearly half of whom were overweight or obese.
“The researchers found that the heavier kids were more likely to have more than a handful of yearly prescriptions for rescue inhalers, which contain short-acting drugs such as albuterol that open up the airways when an asthma attack is coming on.
“On average, normal-weight children used 2.8 rescue inhalers a year, whereas obese kids used 3.1.
“The heavy youngsters also used more inhaled steroids, such as Pulmicort or Flovent, which are a mainstay treatment to keep airway inflammation under control on a daily basis in asthmatics.”
The subject has been a preoccupation of mine for years, especially practicing in the South Bronx where we see the historic paradox of obesity and poverty on display every day, although it is by no means confined to the poor. I have written two previous posts on this linkage here and here, where I described some of the physiology: “Researchers have compared the controls on the production of IgG [protective] and IgE [allergic] antibodies in normal and obese patients. They have found that fat cells promote IgE production disproportionately, making obese patients more ‘allergic’ than is healthy. There is evidence that proinflammatory cytokines in fat tissue to contribute to both heart disease and asthma.”
The Kaiser findings express the subject in easier-to-understand terms, namely, the stark numbers on medication use for the obese and the non-obese. They can probably translate the numbers into financial costs with the push of a button and the costs alone ought to convince the most laissez-faire public health thinkers that some sort of integrated approach to these epidemics is justified. The ten percent higher usage of rescue albuterol during the year and the heavier use of controller medications carry a high price tag measured both in dollars and low performance throughout patient lifetimes, not to mention the corollary medical problems associated with being overweight.
Kaiser is to be commended for allowing its data to be mined in this fashion. I look forward to seeing their ideas for dealing with the issues they raise.