Obesity, Dysanapsis, and Peripheral Airway Impairment in Children With Asthma

Child standing on scale, obesity, overweight
Child standing on scale, obesity, overweight
In children with asthma, is excess weight linked to dysanapsis and PAI — and how do all 3 factors affect the risk of uncontrolled asthma?

Overweight and obesity in children with asthma appears to increase the likelihood of dysanapsis and peripheral airway impairment (PAI), according to a study presented at the American College of Allergy, Asthma, and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, from November 4 to 8, 2021.

Researchers sought to determine the effect of obesity on dysanapsis and PAI and establish the effect of obesity, dysanapsis, and PAI on the risk of uncontrolled asthma by evaluating 206 children aged 4 to 18 years with moderate to severe asthma. The researchers found that compared with children of normal weight, obesity increased the odds of dysanapsis by 2.32 (P =.04), while PAI showed an age-dependent effect, with increased odds for children less than 12 years old of 2.09 (P =.08) and for children aged 12 years and above of 54.14 (P =.003). For each unit increase in BMI z-score, there was an increased odds ratio for dysanapsis of 1.57 (P =.009). With respect to PAI, each unit increase in BMI z-score was associated with an increased odds ratio of 1.39 (P =.042) in those less than 12 years old and an increase of 4.60 (P =.002) for children aged 12 years and above.

Thus, the researchers determined that the relationship of obesity to uncontrolled asthma was indirect and not significant when adjusted for the direct effect of dysanapsis and PAI, which were highly significant predictors, with an increased odds for dysanapsis in children less than 12 years old of 28.01 (P ≤.001) and for PAI of 3.09 (P =.005). Furthermore, the addition of PAI to dysanapsis increased the percentage of patients with uncontrolled asthma from 50% to 81.5%. 

“Overweight and obesity significantly increase odds of dysanapsis and PAI, in an age specific manner, greatly enhancing the probability of uncontrolled asthma,” concluded the authors.


Jung Y, Jean T, Morphew T, Galant S. Peripheral airway impairment and dysanapsis define risk of uncontrolled asthma in obese asthmatic children. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P077.

This article originally appeared on Pulmonology Advisor