Obesity Changes How Pediatric Asthma Is Measured
Why weight status matters when clinicians assess asthma severity in children
New research suggests that obesity may reduce the reliability of commonly used pediatric asthma severity scores, while also influencing treatment decisions in emergency settings. Children with obesity were more likely to receive intensive therapies even when clinical severity scores were similar.
Study Details
Asthma severity scores are widely used in pediatric emergency departments to guide treatment decisions and determine whether a child should be admitted to the hospital. However, these tools were largely developed without considering how obesity might affect physical exam findings or score interpretation.
Researchers conducted a secondary analysis of a prospective study to evaluate how two commonly used asthma severity tools performed in children with obesity compared with children of normal weight presenting with asthma exacerbations.
The study included 399 children treated in a pediatric emergency department, with approximately one quarter classified as having obesity based on sex-specific weight-for-age above the 95th percentile.
Methodology
Clinicians assessed asthma severity using two established scoring systems, the Asthma Clinical Score and the Pediatric Respiratory Assessment Measure. Higher scores indicate more severe asthma symptoms.
The investigators evaluated how consistently different clinicians rated the same patient, how well scores changed as symptoms improved, and how accurately the scores predicted hospital admission. They also examined whether treatment intensity differed between children with obesity and those with normal weight after accounting for severity scores.
Key Findings
The Asthma Clinical Score showed moderate agreement between clinicians in both children with obesity and those with normal weight.
The Pediatric Respiratory Assessment Measure showed weaker agreement in children with obesity compared with normal-weight peers.
Both scores were less responsive to clinical improvement in children with obesity.
Predictive accuracy for hospital admission was higher in children with obesity despite weaker score responsiveness.
Children with obesity were more likely to receive intravenous steroids, continuous albuterol, and noninvasive ventilation.
Implications for Practice
For families, these findings suggest that weight status may influence how asthma severity is interpreted and treated during emergency visits. Children with obesity may appear more severe based on clinical judgment even when standardized scores show modest changes.
For healthcare providers, the results highlight the importance of recognizing potential limitations of asthma scoring tools in children with obesity. Reliance on scores alone may lead to overtreatment or inconsistent decision-making. Clinicians may need to integrate objective measures, clinical judgment, and awareness of obesity-related physiologic differences when managing pediatric asthma exacerbations.