Can asthma be well controlled with NAEPP guideline care in morbidly obese children? The Breathmobile.

Abstract

BACKGROUND\nObesity is thought to be associated with poor asthma control, increased health resource utilization, and reduced responsiveness to inhaled corticosteroids.\n\n\nOBJECTIVE\nBased on previous experience, our hypothesis was that by improved access to comprehensive guideline care, outcomes in normal weight would be comparable in obese children with asthma.\n\n\nMETHODS\nThis was a retrospective cohort study of predominately Hispanic children (3-18 years of age) in underserved areas of Orange County, California, who enrolled in the Breathmobile Program from 2003 to 2012. Outcomes were examined by using Cox regression and generalized estimating equations analyses, adjusted for potential confounding factors.\n\n\nRESULTS\nClinical outcomes in more than 1,200 children followed up for a mean of 6 visits (standard deviation [SD]\u202f=\u202f2.2) across 403 days (SD\u202f=\u202f112) were improved, on average, regardless of body mass index (BMI). Morbidly obese (MOB) patients were able to achieve significant reductions of approximately 60% or more in report of emergency department (ED) visits, hospitalizations, school absenteeism, usual exercise limitations, and exacerbations to levels that were comparable those of normal weight (NW) patients. The importance of close follow-up, particularly for the MOB patient, was evidenced by achieving 80% cumulative probability of well controlled asthma by visit 3, similar to patients in lower BMI risk groups with good adherence, when the visit interval did not exceed 90 days. These outcomes were achieved across all BMI groups with similar mean step of therapy, adjusted for severity (P < .001).\n\n\nCONCLUSION\nAccess to effective community-based care where trust, education, and continuity of care consistent with National Asthma Education and Prevention Program\xa0(NAEPP) guidelines is possible, as demonstrated by the Breathmobile Program, can provide an opportunity for children with asthma in all BMI categories to achieve well-controlled disease.