Increasing epidemiological studies reported that overweight/obese asthma patients had more frequent and severe symptoms and exacerbations, indicating their asthma management may not be sufficient. Airway hyperresponsiveness (AHR), a significant feature of asthma, was found to link with the body mass index (BMI) with mixed findings using the "direct" methacholine challenge test. The objective was to examine the association between BMI and asthma control, as reflected by the "indirect" AHR with the mannitol challenge test in a paediatric asthmatic population.

A total of 80 subjects with physician-diagnosed asthma, aged 6-18 years were enrolled in this cross-sectional study. Patients were first asked to complete the Asthma Control Test (ACT) questionnaire to self-evaluate their disease status. A mannitol challenge test was then performed to assess their AHR severity.

Seventy-six patients (96%) rated their asthma as well-controlled with an ACT score ≥ 20, but 42 patients (53%) were tested positive in the mannitol challenge test with mild and moderate AHR. While patients with mild AHR had comparable lung functions to those without AHR, patients with moderate AHR showed slightly but significantly lower FEV1 and FEV1/FVC values. Although no significant difference in the BMI values was noted for patients with different levels of AHR, the trend of increasing BMI with age was steeper for patients with moderate AHR.

A high prevalence of AHR (>50%) was found in asthmatic children who self-evaluated with good asthma control. No significant influence of the BMI on the AHR severity could be demonstrated in this population with the "indirect" mannitol challenge test. Since only a small number of overweight/obese subjects were recruited in the present study, further verification of the results with a larger sample size of obese subjects is required.

Asthma is a chronic lung disease affecting 8% of US adults, with significant disparities among racial and ethnic groups. The Asian American population is diverse, yet asthma research often aggregates data, potentially obscuring group-specific differences. Disaggregated data reveal that although Asian Americans overall appear to have lower asthma prevalence than non-Hispanic Whites, certain subgroups, like Filipino adults, have higher rates. Asthma outcomes are influenced by genetics, environmental exposures, and social determinants, although the specific impact of these factors remains unclear.

The objective was to better describe asthma outcomes among disaggregated Asian American groups.

We analyzed 2006-18 National Health Interview Survey data on asthma prevalence among non-Hispanic White and disaggregated Asian American adults. Logistic regression was used to calculate adjusted odds ratios (ORs) for Asian American asthma outcomes compared to non-Hispanic Whites, accounting for demographic, health, and socioeconomic factors.

Asthma prevalence varied among adults: non-Hispanic White (n = 33,764), Chinese (n = 310, OR = 0.54), Filipino (n = 603, OR = 1.03), Asian Indian (n = 236, OR = 0.43), and other Asians (n = 601, OR = 0.61). Over half had poor asthma control: 62% non-Hispanic White, 53.5% Chinese (OR = 0.72), 50.2% Filipino (OR = 0.64), 54.8% Asian Indian (OR = 0.75), and 59.2% other Asian (OR = 0.82). Filipino adults showed higher asthma prevalence (OR = 1.37) but better control (OR = 0.74). Chinese (OR = 0.39) and Asian Indian (OR = 0.48) adults had fewer emergency department visits. Sociodemographic and health factors significantly affected symptoms, attacks, and emergency department visits.

Asthma prevalence and control varied widely among Asian American populations. Sociodemographic and health factors influenced poor asthma control more than racial group.

This study aimed to investigate the associations of anaemia status and body mass index (BMI) with asthma severity in adult subjects.

The study included 300 adults who had asthma and admitted to King Abdulaziz Medical City from about 2017 to 2022. The subjects' demographic data, BMI, anaemia status, and number of asthma-related hospital admissions were analyzed. Associations between anaemia, BMI, and asthma severity were investigated within a cross-sectional comparative design. Anaemia status as well as BMI variations may have an impact on the frequency of asthma-related hospitalizations.

Most subjects in the study were female (74.3%) and over the age of 65. Mild anaemia was the most common condition (41.7%), and (42.3%) of subjects were classified as obese and (22.7%) were overweight. Age was found to be a significant factor in asthma-related hospital admissions (p-value = 0.0002), however sex was not significant. Subjects with mild or moderate anaemia and those who were obese had a higher frequency of asthma-related hospital admissions. Furthermore, the study revealed significant differences in the mean number of asthma-related hospital admissions among the different BMI and anaemia status categories. Subjects with severe obesity had a significantly greater number of asthma-related hospital admissions with a mean of 2.21 compared with the other BMI groups (p-value= 0.029). Subjects with mild anaemia had a significantly greater number of asthma-related hospital admissions with a mean of 2.07 than those with severe anaemia (p-value=0.04). These results highlight the importance of considering comorbid conditions in the clinical assessment and management of asthma.

These findings highlight that anemia and BMI abnormalities can complicate asthma management. Health care professionals should be aware of these factors when assessing severity and developing treatment plans. Further research is needed to explore the underlying mechanisms and evaluate interventions targeting anaemia and BMI to improve outcomes.

Asthma poses a significant health burden in South Asia, with increasing incidence and mortality despite a global decline in age-standardized prevalence rates. This study aims to analyze asthma trends from 1990 to 2021, focusing on prevalence, incidence, mortality, and disability-adjusted life years (DALYs) across South Asia. The study also assesses the impact of risk factors like high body mass index (BMI), smoking, and occupational exposures on asthma outcomes.

We extracted asthma data from the Global Burden of Disease database for South Asia (1990-2021). Joinpoint regression analysis was used to assess temporal trends in asthma burden. Total Percentage change (TPC) in age-standardized rates of incidence, mortality, and DALYs were calculated. Data were stratified by gender, and the contribution of risk factors was evaluated.

Asthma-related mortality in South Asia decreased by 37%, from 27.78 per 100,000 (1990) to 17.54 per 100,000 (2021). The Maldives showed the most significant reduction in mortality (78.31%), while Bangladesh recorded a 47.44% reduction in prevalence and a 62.64% decrease in DALYs. High BMI, smoking, and environmental risks contributed significantly to DALYs, with environmental factors playing a major role in countries like Afghanistan (20.73%) and Bhutan (18.58%). Females, particularly those over 20, experienced higher asthma-related DALYs than males.

Asthma burden in South Asia has reduced over the past three decades, yet the absolute number of cases continues to rise, driven by population growth and environmental risk factors. Targeted interventions addressing risk factors and healthcare disparities are essential for further reducing asthma burden.

To examine the impact of medical and recreational cannabis laws on inpatient visits for asthma and by payer-type.

Quasi-experimental difference-in-differences regression analysis was conducted while accounting for variations in cannabis laws implementation timing by states. Inpatient visits for asthma in states with a given type of cannabis law were compared with those in states that did not implement the specific law. Four different cannabis laws were examined in the study-initial passage of medical cannabis law, opening of a medical cannabis dispensary, home cultivation of medical cannabis, and recreational cannabis legalization.

State-level quarterly inpatient visit data for asthma patients were utilized from the Healthcare Cost and Utilization Project Fast Stats database. The primary analysis included inpatient visits for asthma by all payer adult patients aged 19 and above in 38 states from 2005 to 2017, and the secondary analysis included inpatient visits for asthma by payer-type (i.e., private, Medicare, Medicaid, uninsured).

States with medical cannabis dispensaries and legalized recreational cannabis experienced 14.12% (2.14; 95% CI, 0.74-3.53; p < 0.01) and 20.45% (3.08; 95% CI, 1.47-4.69; p < 0.001) increases in inpatient visits for asthma compared with states without these policies, respectively. These increases in inpatient visits for asthma were primarily driven by populations covered by Medicare and private insurance, with Medicare population showing larger effects of both recreational cannabis laws and medical cannabis dispensaries.

States with medical cannabis dispensaries and legalized recreational cannabis experienced higher rate of inpatient visits for asthma compared with states without these policies. Clinicians and policymakers should consider strategies to curb adverse health outcomes of cannabis, that is likely to result in increased costs of healthcare.

Systemic inflammation and oxidative stress are known to exacerbate airway inflammation in asthma. Obesity contributes to this pathophysiology.

To determine the relationship between obesity, disease severity, disease control, and oxidative stress in asthma with multiple oxidative stress markers.

The study included 65 obese-asthma (OA), 25 non-obese asthma (A), and 30 healthy non-obese controls (C). Skin prick tests, lung functions, and 8-isoprostane levels in urine samples were measured. Exhaled breath condensate (EBC) was tested for 8-isoprostane, glutathione peroxidase, and malondialdehyde (MDA). Serum samples were taken for adiponectin and leptin.

OA leptin levels were higher than those of the A and C groups (p < 0.001). Glutathione peroxidase levels in EBC were found to be different between groups (p = 0.016), while there was no difference in two-group comparisons. MDA levels were significant (p < 0.001) between groups, with the A group's lower levels contributing to this significance. 8-isoprostane levels were greater in the OA group than in other groups (p = 0.005). This significance came from the difference between the OA and A groups (p = 0.005). Urine 8-isoprostane levels were different between groups (p = 0.001), and the OA group had lower levels than the A group (p = 0.003). In EBC, there were positive correlations between BMI and MDA (p < 0.001, r = 0.484) and 8-isoprostane (p < 0.001, r = 0.471). Patients with uncontrolled/partially-controlled asthma had greater levels of MDA and 8-isoprostane than those with well-controlled asthma (p = 0.036 and p = 0.011).

Elevated levels of MDAand 8-isoprostane in EBC in obese asthma support that obesity increases oxidative stress markers. This relationship indicate that antioxidant therapies may be beneficial in OA patients. EBC is a reliable and noninvasive technique for measuring oxidative inflammation.

Asthma is characterized by bronchoconstriction and airway hyperresponsiveness. Interplay of environmental and genetic factors led to significant rise in asthma prevalence in India during past decades.

This study investigated functional insights of prostaglandin-endoperoxide synthase 2 (PTGS2) rs689466 polymorphism among 155 pollen-induced patients and 155 controls in West Bengal population, India.

Genotyping was performed using Polymerase chain reaction-Restriction fragment length polymorphism. Transcription Factors (TFs) for promoter region corresponding to the polymorphism location were searched by SNP2TFBS. DNA structures were docked with TFs in HDOCK. Protein-DNA interface was analysed by DNAproDB. Relative abundance of PTGS2 mRNA in controls and different polymorphic genotypes was obtained using Real time PCR. Protein expression was analyzed by western blot.

Genotype and allele frequencies differed significantly between study groups (P = 0.01 and 0.03 respectively). Frequency of GG and AG genotype was significantly higher in patients (P = 0.02 and 0.04 respectively). Significant differences in FEV1/FVC were obtained in different polymorphic genotypes of patients (P < 0.0001) whereas no difference was found in controls (P = 0.08). It was predicted PTGS2 expression decreased due to altered interactions between DNA and TFs in promoter region harbouring the polymorphism. PTGS2 mRNA expression was upregulated in patients bearing AA genotype whereas downregulated in patients with AG and GG genotypes. Protein expression was reduced in AG and GG carrying patients compared to patients bearing AA genotype.

This study is the first one to report association of PTGS2 rs689466 polymorphism in Indian population. This will help in gene-based therapy for improved asthma management in future.

Asthma is a complex and chronic respiratory condition that affects both adult and pediatric populations. Several asthma endotypes have been described; they include endotypes characterized by TH2 cell inflammation, response to viral infection, and exposure to air pollution. Recent evidence has revealed a novel endotype of pediatric asthma, termed the frequent exacerbator (FE) endotype, which is characterized by recurrent exacerbations. In this review, we provide an overview of the FE endotype. We review its epidemiology, its definition, and its environmental and clinical associations. We also detail findings from recent molecular characterizations of a pediatric FE endotype, with a specific focus on airway gene expression studies. As asthma exacerbations drive mortality and economic burden associated with disease, understanding the factors leading to frequent exacerbations is an important step in development of novel therapeutics and treatment strategies.

Asthma and type 2 diabetes are two important causes of morbidity globally. We examined both the association of type 2 diabetes with asthma in Swedish adults and the familial co-aggregation of the diseases.

We conducted a cross-sectional study of all adults aged 25-85 in Sweden between 2009 and 2013. Asthma and type 2 diabetes status were ascertained from the health registers. Models were adjusted for sex, age, education level, income and country of birth and in a subset, for body mass index (BMI). We further conducted a familial coaggregation analysis to determine if shared familial factors could explain any observed findings.

The study included 5 299 245 participants, 25 292 (0.5%) had both asthma and type 2 diabetes. In the total population, the OR for the association between type 2 diabetes and asthma was 1.47 (95% CI 1.45 to 1.49); in the population of men (1.30 (95% CI 1.27 to 1.32)) and women (1.63 (95% CI 1.60 to 1.66)). The ORs were slightly higher among men (1.51 (95% CI 1.45 to 1.56)) and women (2.04 (95% CI 1.96 to 2.11)) for whom BMI measurements were available but attenuated with adjustment for BMI (1.45 (95% CI 1.40 to 1.51)) and (1.76 (95% CI 1.68 to 1.84)). Diabetes was more likely if a full sibling had asthma than if the sibling did not (1.13 (95% CI 1.10 to 1.15)).

We found an association between asthma and type 2 diabetes that was sustained after adjusting for BMI, indicating that BMI alone does not explain this relationship. We also found that the two conditions coaggregate in siblings, indicating that the association is partly due to shared familial genetic and environmental risk factors.

Asthma patients with comorbid obesity tend to have more severe, difficult-to-control asthma than lean asthma patients. This increase in asthma severity may be due, in part, to obesity-related adipokines, such as leptin, which contribute to airway hyperresponsiveness, sustained subclinical chronic inflammation, and treatment resistance. This narrative literature review aims to elucidate the differences in airway eosinophilia and neutrophilia profiles between asthma patients with and without obesity.

A PubMed search of full journal articles published between 1992 and 2024 was performed in April 2024 using the terms "asthma", "tissue eosinophilia" and "obesity" combined with the Boolean operator "AND". Articles detailing airway tissue eosinophilia and neutrophilia in asthma patients or mice were included. Only articles in English were included.

To date, several studies have reported increased airway tissue eosinophilia in obese mouse asthma models (four studies) and in asthma patients with obesity (three studies). Airway tissue eosinophilia in asthma patients with obesity is driven by altered and elevated levels of adipokines, pro-inflammatory cytokines, and eosinophil-stimulating chemokines such as eotaxin. Leptin and eotaxin levels are increased in asthma with obesity and contribute to enhanced eosinophil recruitment, migration, adhesion to airway smooth muscles and fibroblasts, and reduced apoptosis.

Airway tissue eosinophilia is an important feature of obesity-associated asthma. Airway tissue eosinophilia is mainly driven by obesity-related homeostatic changes. These increased airway tissue eosinophils contribute to a more severe disease.

To investigate the impact of severe obesity on the severity of pediatric obstructive sleep apnea (OSA).

Retrospective case series.

Tertiary stand-alone pediatric hospital.

Consecutive children with obesity (≥95th percentile body mass index [BMI]) who underwent full-night polysomnography between January 2021 and December 2021 were analyzed. Patients were categorized into obesity (≥95th percentile BMI and <120% of the 95th percentile) and severe obesity (≥120% of the 95th percentile BMI). The association between severe obesity and severe OSA was assessed using multiple logistic regression.

The study included 282 patients with a median age of 9.2 years (interquartile range 5.9-12.3), 63% male, and 65% Hispanic. In total, 53% were severely obese. Severely obese children had a higher prevalence of severe OSA (53% vs 33%, P < .001) and very severe OSA (apnea-hypopnea index ≥ 24; 24% vs 11%, P = .006). Multiple logistic regression revealed that severe obesity was associated with severe OSA (adjusted odds ratio [aOR] = 3.44; 95% confidence interval [CI], 1.82-6.53; P < .001) after adjusting for age, sex, and tonsillar hypertrophy. Among 170 patients who underwent posttonsillectomy polysomnography, 29% exhibited residual OSA, with 19% having residual severe OSA. Class 3 severe obesity was associated with residual OSA (aOR = 4.05, 95% CI = 1.09-15.00).

Children with severe obesity face substantial sleep disturbances and a heightened risk of residual OSA following adenotonsillectomy.

Asthma exacerbation due to occupational exposure is highly prevalent among adults with asthma. This study assessed the association between occupational risk factors and asthma exacerbation and estimated the impact of asthma exacerbations on job change, sick leave and work ability.

In a prospective study of respiratory health in Telemark, Norway, 1857 adult participants with physician-diagnosed asthma were invited to participate in a follow-up survey. Among those who responded, 740 were found eligible for this study. Participants were categorized into overall, mild, and severe asthma exacerbation groups based on self-reports of hospitalization, doctor or emergency visits for breathing difficulties, or increased or new use of lung medications. Logistic regression, adjusted for age, sex, and smoking, was used to assess associations between self-reported asthma exacerbation and exposure to VGDF, job exposure matrix (N-JEM) data, job change, sick leave, and work ability.

Asthma exacerbation occurred in 140 (19%) responders; 83 had mild exacerbations and 57 severe exacerbations. Severe exacerbation was associated with daily VGDF exposure (OR 2.57, 95% CI 1.15-5.78) and accidental peak exposure to irritants (OR 4.62, 95% CI 1.13-18.85). Both overall and severe exacerbation were associated with job changes (OR 5.40, 1.26-5.65; OR 3.06, 1.16-8.07), sick leave (OR 1.94, 1.33-2.85; OR 2.78, 1.57-4.92), and reduced work ability (OR 1.61, 1.04-2.49; OR 2.17, 1.18-3.98).

Asthma exacerbation was associated with VGDF exposure and some N-JEM occupational exposures. Reducing workplace exposure may decrease job-change, sick leave, and improve work ability in individuals with asthma exacerbation.

The consequences of chronic pulmonary illness are known to exacerbate in individuals with metabolic syndrome and insulin resistance. However, the relationship between triglyceride-glucose (TyG) index, a reliable alternative biomarker of metabolic dysfunction, and chronic respiratory diseases (CRDs) are inconclusive.

Our research involved a total of 7,819 adult individuals diagnosed with CRDs who participated in the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2018. To assess the correlation between the TyG index and survival rates, we employed multivariable weighted Cox regression analysis, smoothing curve fitting, survival curve analysis and subgroup analysis to investigate the relationship.

Higher TyG index among CRDs shown a substantial positive correlation with all-cause mortality after controlling for relevant confounders. The restricted cubic spline analysis showed a nonlinear relationship between the TyG score and all-cause mortality in CRDs. Patients with higher TyG indexes had a greater risk of all-cause mortality according to Kaplan-Meier survival curves.

The clinical relevance of the TyG index in predicting the life expectancy of individuals with CRDs is highlighted by our research. The TyG index can serve as a substitute biomarker for monitoring the wellbeing of the individuals with CRDs.

Obesity is linked to a greater risk of respiratory diseases. Due to limitations in body mass index (BMI), alternative anthropometric indicators have been developed to reflect body fat distribution. This study compares six anthropometric measures-BMI, waist circumference (WC), the waist-to-height ratio (WHtR), the body roundness index (BRI), the body shape index (ABSI), and the weight-adjusted waist index (WWI)-and their relationships with the prevalence and mortality of obstructive sleep apnoea (OSA), asthma, and chronic obstructive pulmonary disease (COPD) in the US population. Data from four NHANES cycles were analyzed. Multivariable logistic regression assessed the cross-sectional associations between the six anthropometric measures and disease prevalence. Mortality associations were analysed via Cox proportional hazards models, and time‒dependent ROC curve was utilised to evaluate the predictive performance of the significant marker for mortality. BMI, WC, WWI, BRI, ABSI, and WHtR were positively correlated with the prevalence of OSA, and COPD. For asthma, BMI, WC, BRI, and WHtR were positively associated with prevalence, while ABSI and WWI were negatively associated. Concerning mortality, higher WC and BMI were associated with better survival in the OSA and COPD groups, whereas elevated WWI and ABSI were linked to greater mortality risk in the participants with OSA symptoms. An increase of one standard deviation (SD) in the ABSI resulted in an 18% increase in mortality (95% CI 1.09-1.27) for the OSA population. The area under the curve (AUC) for ABSI was 0.752 for 3-year, 0.755 for 5-year, and 0.744 for 10-year mortality. Novel anthropometric indicators, including WWI, BRI, ABSI, and WHtR, show positive associations with the prevalence of OSA, and COPD, alongside traditional measures like BMI and WC. However, WWI and ABSI were more limited in their association with asthma prevalence. Longitudinal analyses revealed that traditional anthropometric indicators such as BMI and WC were negatively associated with mortality risks in the OSA and COPD, supporting the "obesity paradox." ABSI, however, emerged as a significant mortality predictor for OSA, providing a more nuanced view of central obesity's impact on mortality. However, in COPD patients, routine anthropometric measurements may not fully capture the effects of obesity.

Respiratory failure (RF) lead to high mortality rates and extended hospital stays in intensive care unit (ICU). The Triglyceride-Glucose (TyG) index, a reliable surrogate marker for insulin resistance (IR), predicted adverse outcomes in various diseases. Combining weight-related indices like body mass index (BMI) with TyG to form the TyG-BMI enhanced the assessment of IR and its impact on patient outcomes. However, the association between TyG-BMI and outcomes in patients with RF remained underexplored. This study retrospectively analyzed data from the MIMIC-IV database, focusing on critically ill patients with RF. From an initial cohort of 19,429 patients, 2177 met the inclusion criteria and were divided into quartiles based on TyG-BMI values. Key clinical information was collected within the first 24 h of ICU admission, including demographics, lab results, vital signs, and scoring systems such as SAPS II and SOFA. Primary outcome was 28-day, secondary outcomes were 180-day and 1-year mortality. Data were analyzed using multivariable Cox regression models, Kaplan-Meier survival curves, and restricted cubic splines to assess the nonlinear relationship between TyG-BMI and mortality. The study found significant differences in baseline characteristics across TyG-BMI quartiles. Kaplan-Meier survival curves indicated a higher survival probability for patients in the lowest TyG-BMI quartile (Q1) compared to higher quartiles (Q2-Q4). Adjusted hazard ratios demonstrated a nonlinear association between higher TyG-BMI values and increased mortality risk at all three time points. The RCS-derived cut-off value of 269 for TyG-BMI was identified as a significant threshold, with higher TyG-BMI values correlating with lower mortality risks. Subgroup analyses reinforced these findings across different patient demographics and clinical profiles. Higher TyG-BMI was associated to lower short-term and long-term mortality, suggesting a potential protective effect. These findings highlighted the importance of the TyG-BMI as a robust prognostic marker, providing valuable insights for improving treatment strategies for patients with RF.

To explore how nutritional status impacts treatment efficacy and future asthma risk in infants with bronchiolitis. A retrospective analysis of 473 RSV-induced bronchiolitis cases from 2015 to 2018. No significant demographic differences. Obese infants showed increased respiratory distress, wheezing, and rapid breathing, with lower oxygen saturation. Elevated IgE and tumor necrosis factor-α (TNF-α) levels persisted in the obese group. A higher asthma incidence was observed after 5 years in this group. Nutritional status is crucial for bronchiolitis management; obesity prevention should be highlighted in asthma programs.

Lung cancer, the third leading cause of death in England, is challenging to diagnose early. Traditional methods are costly, time-consuming and uncomfortable. Exhaled breath condensate (EBC) analysis with the Inflammacheck® device offers a non-invasive alternative, employing advanced analytics like t-distributed stochastic neighbour embedding (t-SNE), Bhattacharyya distances and network maps to differentiate respiratory conditions. The VICTORY study recruited participants (age ⩾ 16) with physician-confirmed respiratory conditions (asthma, chronic obstructive pulmonary disease, bronchiectasis, interstitial lung disease, lung cancer, pneumonia or a breathing pattern disorder) from inpatient and outpatient settings at a single NHS university hospital. EBC was collected using the Inflammacheck® device, to assess seven parameters: H2O2levels, peak CO2percentage, peak breath humidity, peak breath temperature, exhalation flow rate, exhalation duration and sample collection time. After standardisation of EBC data, t-SNE was employed, Bhattacharyya distances calculated on tSNE components, network maps generated, and hierarchical clustering performed to illustrate the distinct classifications of the respiratory conditions based on the EBC parameters. The study included 282 participants. Multinomial logistic regression revealed elevated exhaled H2O2increased the odds of pneumonia (25.7-fold) and lung cancer (3.6-fold). t-SNE analysis showed distinct disease clusters, with Bhattacharyya distances for lung cancer and pneumonia demonstrating good separability from other conditions. Hierarchical clustering confirmed clear group distinctions, as visualised in heatmaps and dendrograms. The integration of advanced dimensionality reduction techniques t-SNE, combined with Bhattacharyya distance-based network mapping to interpret the EBC results facilitated discrimination between respiratory diseases. These methods were chosen over standard machine-learning classifiers due to their ability to provide intuitive, interpretable visualisations of complex data relationships, complementing their strong discriminatory power. Harnessing these analytical tools facilitated disease discrimination, particularly for lung cancer and pneumonia, suggesting promise as a diagnostic aid, paving the way for improved clinical decision-making and patient care.

The aim of this narrative review is to explore possible connections that might lead to both obesity and asthma; it will explain factors and mechanisms involved in disease pathogenesis, focusing particularly on diet and nutrients, the microbiome, inflammatory and metabolic dysregulation, lung function, the genetics/genomics of obese asthma, risk of exacerbation, atopy, and response to treatment. It highlights the role that obesity plays as a risk factor for and disease modifier of asthma, understanding the evidence supporting lifestyle changes in influencing disease progression. Pathophysiological mechanisms in obesity-related asthma have influences on the course of disease pathology. Due to these factors, the child with obese asthma needs a specific therapeutic approach taking into account the common unresponsiveness to bronchodilators, increased requirements for controller medications, poorer steroid effectiveness, and better response to leukotriene receptor (LTR) inhibitors. Therapeutic strategies centered on prevention are suggested and the development of resources to assist families with weight loss strategies and lifestyle changes is shown to be useful for effective weight control and optimal asthma management. Obese children with asthma generally should receive interventions that encourage daily physical activity, weight loss, and normalization of nutrient levels, and monitoring of common obesity-related sequelae should be considered by healthcare providers managing obese children with difficult to control asthma. Recognizing and identifying an asthmatic patient is not always easy and a detailed medical history of the patient, with particular attention paid to their presenting and past symptoms, and a complete physical examination play pivotal and fundamental roles in determining the final diagnosis.

Obesity has a significant impact on asthma incidence and control. Nesfatin-1, encoded by the nucleobindin-2 (NUCB2) gene, regulates energy balance. This study aimed to evaluate NUCB2 gene polymorphism (rs757081 C > G) and its association with serum levels of nesfatin-1 and inflammatory cytokines in obese and non-obese patients with asthma.

Obese (n = 43) and non-obese (n = 44) patients diagnosed with asthma and 45 control subjects were included. Nesfatin-1, eosinophil cationic protein (ECP), and periostin were studied in serum samples using the ELISA method. NUCB2 polymorphism was studied by PCR method.

No difference was found between groups regarding NUCB2 polymorphism (CC, CG, GG) (p = 0.497). Nesfatin-1 levels were higher in the obese asthmatics than in the control (median 1.69 ng/ml vs 1.36 ng/ml, p = 0.004). ECP levels were higher in the obese asthmatics (median 7.67 ng/ml) compared to non-obese asthmatic (median 1.98 ng/ml) and control (median 1.45 ng/ml) (p < 0.001, p < 0.001 respectively). Periostin was found to be lower in both obese (median 0.34 ng/ml) and non-obese asthmatics (median 0.35 ng/ml) compared to control (median 1.2 ng/ml) (p = 0.001, p < 0.001, respectively). There was a positive correlation between BMI and nesfatin-1 (r = 0.33, p < 0.001) and ECP (r = 0.58, p < 0.001). In regression analysis, ECP (95% CI: 0.19 to 0.75, p = 0.005) and periostin (95% CI: 4.5 to 375.1, p = 0.003) were independent predictors for asthma.

Nesfatin-1 and ECP have been shown to be increased in obese asthmatics. ECP and periostin have been identified as a predictor of asthma independent of obesity.

To describe the associations between asthma and relevant comorbidities, and appraise the latest evidence on the management strategies of asthmatics with comorbid conditions.

Conditions such as allergic rhinitis, chronic rhinosinusitis with and without nasal polyps, gastroesophageal reflux disease, obesity, chronic obstructive pulmonary disease, bronchiectasis, anxiety and depression have been linked to worse outcomes in asthma. Recognition and treatment of these conditions is important in asthma, particularly in those with uncontrolled or severe asthma. Biologics for asthma have been effective in those with chronic rhinosinusitis with nasal polyps and chronic obstructive pulmonary disease (COPD), with emerging evidence in bronchiectasis. Weight loss programs with diet and exercise improve asthma control. Anxiety and depression are often unrecognized in patients with asthma.

Comorbid conditions have been recognized as important factors in the diagnosis and treatment of asthma, particularly in patients who have severe disease and remain uncontrolled. Comorbidities in asthma are correlated with poor quality of life and asthma control, increased healthcare utilization and their treatment is associated with improved outcomes.

Discussions on asthma management tend to focus on the therapeutic aspects when updates on asthma strategies are released. However, many other components of asthma management are now receiving increased attention, as we seek to make right on health disparities and strive toward health equity. In addition, with the therapeutic aspects of asthma, we now realize that our anti-inflammatory approaches largely address the high T2 component of airway inflammation. However, we know very little about what we can do to control the other inflammatory features that contribute to asthma. Factors, such as environmental exposures, social determinants of health, and risk-taking behaviors may be at the root of asthma persistence, progression, and comorbidities. We will continue to learn methods to identify these issues and draw them into a shared decision-making approach for dialogue with patients and their caregivers. This review provides information and tools to address the nonpharmacologic aspects of asthma management.

The rising prevalence of overweight and obesity across the globe is a major threat both to public health and economic development. This is mainly due to the link of obesity with the development and outcomes of non-communicable diseases (NCDs). NCDs are a leading cause of global death and disability, and reducing the burden of NCDs on patients and healthcare systems is of critical importance to improve public health. Obesity is projected to be the number one preventable risk factor for NCDs by 2035, and there is an urgent need to tackle the growing obesity rates in order to reduce NCD incidence and severity. Here, we review the current understanding of the impact of obesity on NCD burden in general, as well as the epidemiological and mechanistic relationship between obesity and some of the most common classes of NCDs. By literature review, we found that over 70% of NCDs have a documented association with obesity, highlighting the importance of a better understanding of the pathophysiologies underlying obesity/overweight as well as the interaction between obesity and NCDs in order to reduce global disease burden.

Biological mechanisms underlying multimorbidity remain elusive. To dissect the polygenic heterogeneity of multimorbidity in twelve complex traits across populations, we leveraged biobank resources of genome-wide association studies (GWAS) for 232,987 East Asian individuals (the 1st and 2nd cohorts of BioBank Japan) and 751,051 European individuals (UK Biobank and FinnGen). Cross-trait analyses of respiratory and cardiometabolic diseases, rheumatoid arthritis, and smoking identified negative genetic correlations between respiratory and cardiometabolic diseases in East Asian individuals, opposite from the positive associations in European individuals. Associating genome-wide polygenic risk scores (PRS) with 325 blood metabolome and 2917 proteome biomarkers supported the negative cross-trait genetic correlations in East Asian individuals. Bayesian pathway PRS analysis revealed a negative association between asthma and dyslipidemia in a gene set of peroxisome proliferator-activated receptors. The pathway suggested heterogeneity of cell type specificity in the enrichment analysis of the lung single-cell RNA-sequencing dataset. Our study highlights the heterogeneous pleiotropy of immunometabolic dysfunction in multimorbidity.

To examine the relationship between Hemoglobin A1c (HbA1c) and asthma outcomes in an urban cohort of children with asthma.

The AIRWEIGHS Study was a randomized controlled clinical trial of an air cleaner intervention testing the hypothesis that overweight/obese children would experience greater improvement in asthma control compared to normal weight children. The study enrolled 164 children with asthma from Baltimore, MD and assessed HbA1c levels and asthma outcomes during clinic visits at baseline and three months. HbA1c levels were analyzed as a continuous measure and categorized as either normal (<5.7%) or consistent with pre-diabetes (≥5.7%). Asthma outcomes included standardized questionnaires, spirometry, and fractional exhaled nitric oxide (FeNO). Generalized Estimating Equation (GEE) regression models were used to analyze the association between the HbA1c and asthma outcomes.

Participants included 164 children with an average age of 11 (± 2) years, predominately African American (85%), male (59%), moderate or severe asthma by NAEPP criteria (59%), households with an income below $34,999 (60%), publicly insured (83%), and overweight/obese (61%). 52 participants were excluded from the analysis due to unsuccessful blood draws or participant refusal. Twenty of 112 distinct participants (18%) had HbA1c measurements ≥5.7%, consistent with prediabetes. Increased HbA1c levels were associated with worse asthma control as indicated by an increase in the Asthma Therapy Assessment Questionnaire (β-0.74 p<0.05). In the interaction analysis, BMI percentile had a significant interaction with HbA1c such that HbA1c had a stronger association with maximum symptoms days and exacerbation risk among children with lower versus higher BMI percentile values.

Higher HbA1c levels were associated with worse asthma control among children with asthma, adding to evidence that metabolic dysfunction may influence asthma morbidity. Additionally, HbA1c could have a stronger influence among non-obese children with underlying metabolic dysfunction, suggesting the need for future studies to investigate metabolic pathways in asthma.

Obesity is not a single diagnosis, and the association of 'metabolically unhealthy' obesity with cardiovascular disease is well-described. However, the relationship between metabolically healthy obesity (MHO) and atrial fibrillation (AF) is still debated.

Our objective is to investigate the association between MHO and the risk of AF.

A comprehensive search of databases, including PubMed, EMBASE, Web of Science, and the Cochrane Library regarding longitudinal studies of MHO and risk of AF was performed. Random effects were used to pool the effect estimates.

Nine cohort studies comprising 4,250,557 participants were included. The pooled results revealed that individuals with MHO were associated with a greater incidence of AF than those with a metabolically healthy normal weight (HR: 1.34, 95 % CI: 1.26 to 1.42) with moderate certainty according to the Grading of Recommendations Assessment, Development, and Evaluation assessment. Individuals with MHO were associated with a lower risk of AF compared with participants with metabolically unhealthy obesity (RR: 0.48, 95 % CI: 0.36 to 0.64). Individuals with MHO were not significantly associated with the risk of AF as compared to metabolically unhealthy normal weight (HR: 1.04, 95 % CI: 0.89 to 1.22).

MHO is associated with a greater incidence of AF, highlighting the importance of weight reduction in individuals without metabolic disorders in reducing the risk of AF.

PROSPERO - registration number CRD42023432195.

To identify causal risk factors for asthma using a Mendelian randomization (MR) approach.

Genetic variants associated with the exposures at the genome-wide significance level (p < 5 × 10 - 8) were obtained from corresponding genome-wide association studies. Summary-level statistical data for asthma were obtained from the UK Biobank (UKB) and the FinnGen Consortia. Univariate and multivariate MR analyses were performed to clarify causal relationships among obesity, serum lipids, and asthma. Meta-analyses were performed to combine UKB and FinnGen results using a fixed-effects model.

In FinnGen, the odds for asthma increased for every 1-SD increase in body mass index (BMI; odds ratio [OR] 1.292, p = 1.34 × 10-7), together with body fat percentage (BF%; OR 1.449, p = 4.90×10-3), and total cholesterol level (OR = 0.949, p = 0.027). However, higher BMI and BF% were found to increase the risk for asthma in the multivariate MR analysis. In the UKB, the BMI results were replicated. Meta-analysis revealed that high-density lipoprotein cholesterol could also increase the risk for asthma, although there were no associations with other risk factors included in this study.

This MR study found that genetically predicted higher BF% and BMI could increase the risk for asthma and corroborated some risk factors for asthma from previous MR studies. Moreover, the results suggest that higher BMI and BF% could serve as independent risk factors for asthma.

Background: Asthma is a chronic inflammatory disorder in millions of individuals across the globe with high morbidity, mortality, and health care costs. Despite advances in asthma treatment, long-term remission is a challenging target to achieve. Objectives: This review will address the path to remission in asthma with focus on the role of biologic agents in severe asthma management and on the question as to whether long-term disease control and remission are a reality. Methods: A systematic literature review from 1971 to 2025 was conducted through databases such as PubMed, MEDLINE, Scopus, and Web of Science. Clinical trials, meta-analyses, and real-world evidence concerning biologic therapies, such as monoclonal antibodies targeting interleukin -5 (IL-5), IL-4/IL-13, immunoglobulin E, and thymic stromal lymphopoietin, were considered. Symptom control, exacerbation frequency, lung function, and oral corticosteroid (OCS) use were some of the outcomes considered. Results: Biologic treatments have yielded significant gains in asthma control and reduction of exacerbation. Complete remission-long-term resolution of symptoms, inflammation, and drug dependence-is still difficult to achieve. Early intervention with biologics may prevent irreversible airway remodeling, but long-term remission is not in sight. These drugs reduce OCS dependency, but sustainability of remission remains to be investigated. Conclusions: Biologic therapies have advanced asthma treatment, particularly in severe cases, by improving symptoms and reducing exacerbations. However, complete remission remains a distant goal. The development of standardized remission criteria, better patient stratification, and long-term clinical studies are necessary to help achieve sustained asthma control and remission.

Asthma is a prevalent chronic condition, affecting an estimated 260 million people worldwide, according to the 2021 Global Burden of Disease Study. This condition significantly impacts individuals of all ages. One notable finding is that asthma prevalence among adults was higher in females than males. Recent evidence suggests that these disparities in asthma prevalence and outcomes are likely due to complex interactions among hormonal, anatomical, and environmental factors, coupled with societal and behavioral influences. The interchangeable use of the terms "sex" and "gender" in the scientific literature is frequently inconsistent. Biological sex is defined by anatomical and physiological characteristics determined by genetics; "gender", on the other hand, is a more complex construct and a universally accepted definition is still lacking. This lack of clarity, coupled with potential knowledge gaps, misunderstandings, or the inherent difficulty in differentiating sex- and gender-related effects, often leads to the terms being poorly defined or used interchangeably. Such imprecise usage hinders accurate data interpretation and research progress. This paper provides a perspective review synthesizing current knowledge regarding the influence of sex and gender on asthma, specifically focusing on their impact on disease pathogenesis, clinical presentation, severity, and management strategies.

In recent years, an increasing body of evidence has revealed a complex interplay between obesity and asthma, prompting academic and medical communities to intensify their focus on this area of research. The objective of this study is to undertake a comprehensive bibliometric analysis of the research literature pertaining to obesity-related asthma from 2004 to 2023. This analysis aims to provide precise and valuable insights, as well as to systematically reflect upon the current status and emerging trends within the field.

Literature data on obesity and asthma research was sourced from the Web of Science Core Collection database. CiteSpace and VOSviewer were utilized to visually analyze bibliometric indicators such as co-authorship, citation networks, and publication frequency of the data to facilitate the identification of patterns and trends.

A total of 3,118 papers were included in the analysis, encompassing 2,539 articles and 579 reviews. Throughout the last 20 years, the volume of publications has shown a consistent upward trend. The United States and Harvard University are at the forefront of this research field. Professor Dixon Anne E. is recognized as a pioneer and leading figure in the cultivation of obesity-related asthma research. Keyword analysis identified topics such as "childhood asthma," "bariatric surgery," "physical activity," "gut microbiota," "COVID-19," "food allergy," "asthma control," "nutrition examination," and "severe asthma."

The research domain of obesity-related asthma has experienced a substantial growth, with the United States, the United Kingdom, and China leading the global landscape. The focus on asthma in obese adolescents and children, the role of bariatric surgery, and lifestyle interventions remains a consistent area of interest, with considerable potential for further study. These findings provide a scientific basis for the development of personalized treatment programs for obese asthma patients. In addition, this study highlights the importance of further research in the fields of gut microbiota, COVID-19, and food allergy, providing directions for future policymaking.

The development of asthma is impacted by fat. Asthma is more common in obese persons. The purpose of the experimental study is to determine how chromium, formoterol, and their combination can improve the quality of life for obese people with lung anomalies. Thirty-six male Wistar rats were divided into six groups: control (C), obesity (CO), obese-asthma (COA), and obese-asthma groups treated with formoterol (OAF), chromium (OACR), or both (OACRF). Except for group C, all groups received a high-fat diet for 4 weeks. Subsequently, ovalbumin (OVA) was administered subcutaneously (s.c.) to all groups except C and CO to induce sensitization. Asthma was triggered via 1% OVA aerosol challenges on days 26-28. Over 5 days, OAF and OACRF received daily formoterol inhalations (50 μg/kg), while OACR and OACRF were given chromium (400 μg/kg). Treatments were timed to align with asthma induction protocols. Lipid profile and inflammatory indicators were examined at the end of the trial-Immunohistochemical analysis of lung tissue, Histopathological and lung tissue stained with Hematoxylin and Eosin. The combination therapy (OACRF) significantly reduced body weight (p < 0.05), lowered LDL and triglycerides, increased HDL, and normalized lung tissue architecture compared to controls. Immunohistochemistry revealed reduced IL-1β and IL-17α expression. The (OACRF) group demonstrated superior asthma control by reducing body weight, improving inflammatory indicators, and restoring lung tissue to its normal state by administering chromium and formoterol therapy. The most effective strategy for treating both obesity and asthma is to address their two connected conditions. These findings demonstrate that combined chromium and formoterol therapy effectively addresses metabolic and inflammatory components of obesity-induced asthma, offering a promising dual-target therapeutic strategy.

The goal of our study was to investigate the potential relationship between Lipid Accumulation Product (LAP) and prevalence of asthma.

Cross-sectional study.

The National Health and Nutrition Examination Survey (2003-2018).

The study included a total of 13,993 participants, all of whom had complete data on both asthma and LAP.

The Lipid accumulation product (LAP) index is a potential estimator of visceral fat accumulation. Overweight and obesity are the risk factors for asthma. However, no research investigated the possible correlation between LAP and the incidence of asthma.

We undertook a cross-sectional analysis to investigate the link between LAP and asthma, utilizing data from the National Health and Nutrition Examination Surveys (NHANES 2003-2018). To address the complex, multistage, and clustered survey design, sample weights were incorporated into all the statistical analyses. The association between LAP and the prevalence of asthma was examined through multivariable logistic regression. Additionally, the linear correlation between these variables was assessed via smoothed curve fitting and threshold effect analyses. Subgroup analysis was conducted to identify any vulnerable populations.

The study included 13,993 participants, of whom 1965 (14.0 %) were diagnosed with asthma. Following adjustment for all covariates, a notable positive correlation emerged between the LAP index and asthma according to a multivariate logistic regression analysis. A heightened prevalence of asthma was observed with each unit increase in LnLAP (OR = 1.17, 95 % CI = 1.09-1.27, P < 0.001). Compared to individuals in the lowest LAP quartile, those in the highest quartile had a 34 % increased probability of developing asthma. (OR 1.34, 95 % CI 1.13-1.60, P = 0.001). Additionally, smoothed curve-fitting analysis revealed a nonlinear correlation between the LAP index and asthma. Through threshold effect analysis, the inflection point was established at 114.495.

The study found a positive association between the LAP index and asthma in adults, suggesting that LAP may serve as a potential biomarker for early detection of asthma and assessment of treatment efficacy.

Chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease afflict millions of individuals globally and are significant sources of disease mortality. While the molecular mechanisms underlying such diseases are unclear, environmental and social factors, such as cigarette smoke and obesity, increase the risk of disease development. Yet, not all smokers or obese individuals will develop chronic respiratory diseases. The mitogen-activated protein kinase p38α is abnormally active in such maladies, but its contribution, if any, to disease etiology is unknown. To assess whether p38α activation per se in the lung could impose disease symptoms, we generated a transgenic mouse model allowing controllable expression of an intrinsically active variant, p38αD176A+F327S, specifically in lung alveolar type 2 pneumocytes. Sustained expression of p38αD176A+F327S did not appear to induce obvious pathological outcomes or to exacerbate inflammatory outcomes in mice challenged with common respiratory disease triggers. However, mice expressing p38αD176A+F327S in alveolar type 2 cells and fed with a high-fat diet exhibited increased numbers of airway eosinophils and lymphocytes, upregulated levels of proinflammatory cytokines and chemokines including interleukin-1β and eotaxin, as well as a reduction in levels of leptin and adiponectin within the lung. Neither high-fat diet nor p38αD176A+F327S alone induced such outcomes. Perhaps in obese individuals with associated respiratory diseases, elevated p38α activity which happens to occur is the factor that promotes their development.

Asthma is a common, multifaceted respiratory disease with a major impact on quality of life. Despite increased insights into mechanisms underlying various asthma phenotypes and endotypes and the availability of targeted biologic treatment options, the disease remains uncontrolled in a substantial proportion of patients with risk of exacerbations, requiring systemic corticosteroids, and with progressive disease. Current international guidelines advocate for a personalized management approach to patients with uncontrolled severe asthma. The European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA) asthma expert panel was convened to discuss strategies to optimize asthma care and to prevent systemic corticosteroid overuse and disease progression. In this meeting report, we summarize current concepts and recommendations and provide a rationale to implement personalized asthma management at earlier stages of the disease. The ultimate goal is to move away from the current one-size-fits-most concept, which focuses on a symptom-driven treatment strategy, and shift toward a phenotype- and endotype-targeted approach aimed at curbing the disease course by improving clinical outcomes and preserving health-related quality of life. Herein, we provide a consensus view on asthma care that advocates a holistic approach and highlight some unmet needs to be addressed in future clinical trials and population studies.

Asthma is more frequent and severe in individuals with obesity compared to those with normal weight. While inhomogeneity of lung ventilation due to distal airway obstruction is a key feature in asthma, the effect of obesity on ventilation homogeneity is unclear. We conducted a cross-sectional study comparing lung clearance index (LCI) using multiple breath nitrogen washout technique between children with normal weight and asthma (n = 97), overweight/obesity and asthma (n = 100), overweight/obesity and no asthma (n = 100), and children with normal weight and no asthma (n = 67). Spirometry, lung volumes, and fractional exhaled nitric oxide (FeNO) were obtained for comparison. Results showed no significant difference in LCI between overweight/obesity groups and normal weight groups and no significant correlation between LCI and body mass index (BMI). However, LCI was higher in the asthma groups compared to non-asthma groups (p = 0.017, p = 0.003). There was a significant negative correlation between LCI and FEV1% predicted, FEV1/FVC, and FEF25-75% predicted (r = -0.24, p < 0.001; r = -0.26, p < 0.001; r = -0.23, p < 0.001), and a positive correlation with RV/TLC (r = 0.17, p = 0.003) and FeNO (r = 0.29, p < 0.001). These findings indicate that obesity does not affect the homogeneity of lung ventilation. Therefore, alternative mechanisms should be considered to explain the association between asthma and obesity.

Asthma is a significant non-communicable disease affecting over 300 million people worldwide. This study aimed to evaluate the influence of socio-demographic, environmental, and clinical factors on asthma control among patients visiting community pharmacies in Lahore, Pakistan. A multicenter prospective observational study was conducted with 284 participants using a validated data collection tool. Data included demographics and potential confounders such as smoking, obesity, co-morbidities (e.g., allergic rhinitis, gastroesophageal reflux disease [GERD]), and adherence to treatment. Asthma control was classified into full, partial, and uncontrolled levels based on established guidelines. Statistical analyses, including chi-square tests and logistic regression, were performed to identify significant predictors. The results indicated that 53.5% of participants were female, 74.6% were aged above 40 years, and 42.3% were obese. A family history of asthma was reported in 55.6% of participants, while smoking was prevalent in 77.1%. Clinical co-morbidities, such as allergic rhinitis (49.3%) and GERD (50.7%), were notable. Participants who adhered to treatment (62.3%) and engaged in daily exercise (59.5%) exhibited significantly better asthma control. Multivariate analysis revealed that higher education, rural residence, and the absence of obesity were positively associated with asthma control, whereas passive smoking and prolonged asthma history had a negative impact. This study underscores the multifaceted nature of asthma management and the importance of addressing socio-demographic, environmental, and clinical factors. Improved asthma outcomes require targeted interventions, including promoting adherence to treatment plans, encouraging physical activity, and minimizing exposure to smoking and environmental allergens. The findings highlight the need for community-centered strategies to enhance asthma control and reduce its public health burden, particularly in middle-income countries like Pakistan.

Despite regularly used treatment asthma in both children and adults is not fully controlled. This is more prominent in certain disease subtypes, such as obese asthma. The vast complexity of asthma phenotypes and often overlapping endotypes emphasizes the need for implementing the concept of precision medicine in disease management. In order to address these concerns, an innovative and personalized programme for reducing excessive and maintaining a healthy body weight will be developed by experts from pharmaceutical and food industry (Belupo Inc. and Podravka Inc., Croatia) as well as clinical experts (Srebrnjak Children`s Hospital, Croatia). The programme will involve meals replacement (standard and innovative formulas), dietary program and nutritional counseling, physical activity and other individually tailored measures according specific disease phenotypes and underlying pathophysiological mechanisms in each participant. The outcomes of this study should contribute to better control of the underlying condition, reduction of the frequency and severity of symptoms and, consequently, in the improvement of the participant's overall quality of life.

The objective of this study was to investigate the effects of total dietary energy intake on asthma.

The study was a retrospective cross-sectional study of Americans aged 1-18 year. Comprehensive demographic, dietary, examination, laboratory, and asthma questionnaire data were collected for each participant. Multivariate logistic regression, restricted triple spline curves, threshold effects, and stratified analyses were used for analysis.

Of 12,090 participants, 1,893 (15.66%) had a diagnosis of asthma. After accounting for potential confounders, compared with the group with the lowest energy intake (Q1), groups 2 (Q2), groups 3 (Q3), and groups 4 (Q4) had adjusted odds ratios (ORs) of 0.72 (0.62-0.85), 0.63 (0.51-0.77) and 0.55 (0.43-0.7) for asthma. The relationship between total energy intake and asthma showed an L-shaped curve (p = 0.001). The results were further verified by stratification and sensitivity analyses. In the threshold analysis, we found that the saturation effect was reached at a total energy intake of 56.442 kcal/kg/day with an OR of 0.981 (0.973-0.989).

The prevalence of asthma in Americans aged 1-18 years was associated with total dietary energy intake in an L-shaped curve, with a significant turning point found at approximately 56.442 kcal/kg/day.

Asthma is the commonest chronic condition of childhood. Children with asthma in the UK have the worst outcomes across Europe and other high-income countries. There are significant socioeconomic inequalities that impact the prevalence and outcomes of asthma (emergency healthcare utilisation, hospitalisation, critical care admission, mortality and quality of life). In this review we discuss these inequalities and the underlying mechanistic links, using the UK as an example of how poverty in a high-income country results in inequality in asthma outcomes. These inequalities and underlying mechanisms need to be understood by clinicians, policymakers and wider stakeholders to be redressed such that avoidable harm and asthma deaths in children can be prevented.