Comparative response to pharmacological management of asthma in overweight/obese children versus their counterparts: a systematic review and call for data
Abstract
Background: Obese children with asthma experience higher morbidity than their counterparts; whether different treatments should be considered remains to be clarified.
Objective: To explore the potential group differences in the treatment response to any asthma medications between overweight/obese and normal/underweight children.
Methods: We systematically reviewed case-control, cohort studies and randomised controlled trials (RCTs) examining treatment effects by weight status, identified in four bibliographic databases from inception until January 2025. A narrative synthesis was presented because a meta-analysis could not be conducted due to methodological issues.
Results: Nine studies (one RCT, five post hoc analyses of RCTs, two cohorts, and one post hoc analysis of a case-control study), including 7089 children (33.9% overweight/obese), met the inclusion criteria. Pharmacological treatment pertained to step 1-2 (n=1), step 2 (n=3), step 3 (n=2), step 5 (n=2), and bronchodilator-response (n=1). Compared with normal weight, step 1-2 showed a trend toward reduced inhaled corticosteroid (ICS) efficiency in minimising symptom days in overweight/obese preschoolers. Regarding step 2 monotherapy, overweight/obese children may benefit as much (or more) from nedocromil or leukotriene receptor antagonist (LTRA) than from ICS. In step 3, adding LTRA (versus placebo) to ICS monotherapy was more effective, whereas higher-dose ICS monotherapy was less effective than LTRA or long-acting…
How strong is the evidence?
Evidence Hub reads this as a systematic review, done in people. Its evidence level is 1 of 5 (Highest · pooled evidence). Pooled evidence from several studies sits at the top of the evidence pyramid. Reported size: 7,089 participants or records.
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