Obesity and Asthma: A Dangerous Link in Children

An Integrative Review of the Literature

Karen Rance, DNP, CPNP, AE-C; Mary O'Laughlen, PhD, FNP-BC

Disclosures

Journal for Nurse Practitioners. 2011;7(4):287-292. 

In This Article

Relationship of Asthma, Obesity, and Inactivity

A growing body of literature implicates decreased physical activity as a contributor to the increase of asthma prevalence.[25] Obesity leads to increased asthma symptoms and worsening disease, which itself can be associated with less physical activity. Less physical activity, in turn, predisposes a patient to obesity and long-term respiratory problems, thereby sustaining the vicious cycle of inactivity, obesity, and worsening asthma.[35] Lucas and Platts-Mills[35] found that asthmatic children have a lower aerobic fitness level than their non-asthmatic peers, citing a complex inter-relationship between asthma, obesity, and inactivity.

National activity guidelines for children recommend 60 or more minutes of physical activity daily, and it is estimated that the majority do not meet this goal, including children with asthma and those who are overweight.[14,36] Rasmussen et al.[37] demonstrated the level of physical fitness among schoolchildren age 8 years or older is inversely related to provider-diagnosed asthma, concluding that the less physically active a child, the more likely he or she is to develop asthma. Abramson et al.[38] proposed a vicious cycle occurring between asthma and inactivity in that having a diagnosis of asthma often results in behavioral changes, such as a diminished enthusiasm for physical activity. This in turn influences weight trajectories and increases the risk of developing obesity, thereby exacerbating poor health outcomes.[38]

The effect of increasing physical activity on overall health status has long been recognized as a possible method of improving asthma outcomes, despite its possible contribution to increasing morbidity in some.[35] Because excess weight may adversely affect the respiratory health of children with asthma, weight management and increasing physical activity for overweight and obese children is an important component in their care.[35] Life-long exercise increases lung function.[27] Activities such as running and swimming, if tolerable, are associated with improved fitness and decreased severity of asthma symptoms, making them great suggestions to share with patients.[28]

Research demonstrates that asthma severity contributes to lower activity level among some school-aged children.[39,40] However, Westermann et al.[41] caution against assuming a direct causal link between asthma severity and increased symptoms with physical activity and suggests the presence of external influences has greater effect than severity level. Lang et al.[39] found that negative parental health beliefs, such as external or self-imposed restraints placed on asthmatic child's activity levels, unnecessarily prevent the children from participating in physical activity (see Table 1). The researchers demonstrated that while 98% of parents with asthmatic children believed exercise was important for children, 35% believed exercise made their child's asthma worse, 26% believed their child would get sick if they exercised, 18% believed exercise was dangerous for their child because they had asthma, and 6% believed their child should never exercise at all.[39]

The lines of causation remain blurred between asthma, obesity, and inactivity, evoking a discussion as to "which came first." The reality is that any of the 3 may be the primary causative condition in any given patient, hence the challenge of treatment. The nurse practitioner, as clinician and educator, is in a key position to improve the health outcomes for these children.

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