Award Date

December 2016

Degree Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Environmental and Occupational Health

First Committee Member

Sheniz Moonie

Second Committee Member

Shawn Gerstenberger

Third Committee Member

Mary Beth Hogan

Fourth Committee Member

Alona Angosta

Number of Pages

129

Abstract

Asthma and obesity are two of the most common comorbid health problems in the U.S. Currently nearly 8% of Nevada youth are affected by asthma and more than 30% are overweight or obese. Obesity is a risk factor for asthma, yet asthma-related factors such as decreased physical activity and use of oral corticosteroids for asthma control can lead to obesity. This study examined the relationship between asthma and obesity in two pediatric populations in Nevada. It was hypothesized that children with asthma and elevated BMI would have more severe asthma symptoms, decreased lung function, poorer quality-of-life measures, and different atopic profiles than those with a BMI in the healthy weight category. This was evaluated using pilot data collected from a University of Nevada, School of Medicine pediatric allergy/immunology clinic in Reno, NV. This study also evaluated whether or not a 12-week physical activity intervention is feasible to complete for pediatric overweight/obese who have asthma compared with overweight/obese without asthma. Weight loss in youth who have asthma has been shown to improve asthma control and lung function. Intervention data were obtained from medical records at the Children’s Heart Center (CHC) Nevada Healthy Hearts Program (HHP) in Las Vegas. Statistical analyses included descriptive statistics, multivariable binary and multinomial logistic regression, Cox regression, and one-way and repeated measures analyses of variance. The Reno population (N=125) had a median age of 7 years old, was 61% male, 65% white, and nearly one-third were overweight or obese. Main findings showed that obese youth with asthma had higher odds of having severe asthma than those at healthy weight, though not significantly higher (p=0.162). Lung function was not different among BMI percentile groups, yet those who were obese did have nearly 8 times higher odds of needing oral steroids for asthma control than those who were healthy weight (p=0.003). Children who were overweight had 79% lower odds of allergen sensitization (aOR 0.21, p=0.010). The CHC population (N=232) had a mean age of 11 years, 54% male, 64% Hispanic, and 37% had asthma. Crude analyses of the HHP population showed that BMI did decrease significantly among those with asthma (p=0.002) and without asthma (0.001) from pre- to post-intervention. Cardiorespiratory health increased significantly among girls (p=0.004) and boys (p=0.003) who have asthma, as well as among both girls (p=0.001) and boys (p=0.001) without asthma. Multivariable analysis demonstrated no difference in attrition between those with and without asthma (p=0.300), and no difference in weight loss (p=0.951) or cardiorespiratory health (males, p=0.263, females, p=0.655) between participants with and without asthma, indicating that this intervention was feasible for asthmatics to complete as a form of physical activity engagement and weight management. These results show that obese youth had poorer asthma control than healthy weight children as evidenced by oral steroid use at the initial visit to the clinic, and a high degree of allergen sensitization among the entire population, although lower among overweight children. It is important to make sure all children with asthma in Nevada are tested for allergen sensitization regardless of weight status. Mean BMI decreased and VO2 max increased indicating that this program was also beneficial in improving respiratory outcomes for youth who have asthma. Future studies may be conducted to expand this intervention in order to determine the efficacy of physical activity, weight reduction and lung function improvement among a larger clinical population of asthmatics.

Disciplines

Public Health

Language

English


Included in

Public Health Commons

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