Search tips
Search criteria 


Logo of thoraxThoraxVisit this articleSubmit a manuscriptReceive email alertsContact usBMJ
Thorax. 2003 December; 58(12): 1036–1041.
PMCID: PMC1746552

Association of body mass with pulmonary function in the Childhood Asthma Management Program (CAMP)


Background: While increases in body mass index (BMI) have been associated with the incidence and prevalence of asthma, the mechanisms behind this association are unclear.

Methods: We hypothesised that BMI would be independently associated with measures of asthma severity in a population of children with mild to moderate asthma enrolled in the Childhood Asthma Management Program (CAMP). A multivariable baseline cross sectional analysis of BMI with our outcomes of interest was performed.

Results: BMI was generally not associated with symptoms, nor was it associated with atopy. While BMI was positively associated with the methacholine concentration that causes a 20% fall in forced expiratory volume in 1 second (PC20FEV1), this association did not persist after adjustment for FEV1. Increasing BMI was associated with increasing FEV1 (ß = 0.006 l, 95% CI (0.001 to 0.01)) and forced vital capacity (FVC) (ß = 0.012 l, 95% CI (0.007 to 0.017)). However, decrements in the FEV1/FVC ratio were noted with increasing BMI (ß = –0.242, 95% CI (–0.118 to –0.366)). Thus, an increase in BMI of 5 units was associated with a decrease in FEV1/FVC of over 1%.

Conclusions: Although the association of FEV1 and FVC with BMI did not support our initial hypothesis, the decrease noted in the FEV1/FVC ratio has potential relevance in the relationship between BMI and asthma severity.

Full Text

The Full Text of this article is available as a PDF (256K).

Supplementary Material

[Web-only Appendix]

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Mannino DM, Homa DM, Pertowski CA, Ashizawa A, Nixon LL, Johnson CA, Ball LB, Jack E, Kang DS. Surveillance for asthma--United States, 1960-1995. MMWR CDC Surveill Summ. 1998 Apr 24;47(1):1–27. [PubMed]
  • Figueroa-Muñoz JI, Chinn S, Rona RJ. Association between obesity and asthma in 4-11 year old children in the UK. Thorax. 2001 Feb;56(2):133–137. [PMC free article] [PubMed]
  • Epstein LH, Wu YW, Paluch RA, Cerny FJ, Dorn JP. Asthma and maternal body mass index are related to pediatric body mass index and obesity: results from the Third National Health and Nutrition Examination Survey. Obes Res. 2000 Nov;8(8):575–581. [PubMed]
  • Gold DR, Rotnitzky A, Damokosh AI, Ware JH, Speizer FE, Ferris BG, Jr, Dockery DW. Race and gender differences in respiratory illness prevalence and their relationship to environmental exposures in children 7 to 14 years of age. Am Rev Respir Dis. 1993 Jul;148(1):10–18. [PubMed]
  • Lee SI, Shin MH, Lee HB, Lee JS, Son BK, Koh YY, Kim KE, Ahn YO. Prevalences of symptoms of asthma and other allergic diseases in korean children: a nationwide questionnaire survey. J Korean Med Sci. 2001 Apr;16(2):155–164. [PMC free article] [PubMed]
  • Rodríguez Michael A, Winkleby Marilyn A, Ahn David, Sundquist Jan, Kraemer Helena C. Identification of population subgroups of children and adolescents with high asthma prevalence: findings from the Third National Health and Nutrition Examination Survey. Arch Pediatr Adolesc Med. 2002 Mar;156(3):269–275. [PubMed]
  • Gennuso J, Epstein LH, Paluch RA, Cerny F. The relationship between asthma and obesity in urban minority children and adolescents. Arch Pediatr Adolesc Med. 1998 Dec;152(12):1197–1200. [PubMed]
  • Martinez FD, Wright AL, Taussig LM, Holberg CJ, Halonen M, Morgan WJ. Asthma and wheezing in the first six years of life. The Group Health Medical Associates. N Engl J Med. 1995 Jan 19;332(3):133–138. [PubMed]
  • Meurer JR, George V, Subichin S, Yauck J, Layde P. Asthma severity among children hospitalized in 1990 and 1995. Arch Pediatr Adolesc Med. 2000 Feb;154(2):143–149. [PubMed]
  • Gold DR, Wypij D, Wang X, Speizer FE, Pugh M, Ware JH, Ferris BG, Jr, Dockery DW. Gender- and race-specific effects of asthma and wheeze on level and growth of lung function in children in six U.S. cities. Am J Respir Crit Care Med. 1994 May;149(5):1198–1208. [PubMed]
  • von Kries R, Hermann M, Grunert VP, von Mutius E. Is obesity a risk factor for childhood asthma? Allergy. 2001 Apr;56(4):318–322. [PubMed]
  • Castro-Rodríguez JA, Holberg CJ, Morgan WJ, Wright AL, Martinez FD. Increased incidence of asthmalike symptoms in girls who become overweight or obese during the school years. Am J Respir Crit Care Med. 2001 May;163(6):1344–1349. [PubMed]
  • Rosner B, Prineas R, Loggie J, Daniels SR. Percentiles for body mass index in U.S. children 5 to 17 years of age. J Pediatr. 1998 Feb;132(2):211–222. [PubMed]
  • Dockery DW, Berkey CS, Ware JH, Speizer FE, Ferris BG., Jr Distribution of forced vital capacity and forced expiratory volume in one second in children 6 to 11 years of age. Am Rev Respir Dis. 1983 Sep;128(3):405–412. [PubMed]
  • Schwartz JD, Katz SA, Fegley RW, Tockman MS. Analysis of spirometric data from a national sample of healthy 6- to 24-year-olds (NHANES II). Am Rev Respir Dis. 1988 Dec;138(6):1405–1414. [PubMed]
  • Lazarus R, Colditz G, Berkey CS, Speizer FE. Effects of body fat on ventilatory function in children and adolescents: cross-sectional findings from a random population sample of school children. Pediatr Pulmonol. 1997 Sep;24(3):187–194. [PubMed]
  • Fung KP, Lau SP, Chow OK, Lee J, Wong TW. Effects of overweight on lung function. Arch Dis Child. 1990 May;65(5):512–515. [PMC free article] [PubMed]
  • Inselma LS, Milanese A, Deurloo A. Effect of obesity on pulmonary function in children. Pediatr Pulmonol. 1993 Aug;16(2):130–137. [PubMed]
  • Weiss ST, Van Natta ML, Zeiger RS. Relationship between increased airway responsiveness and asthma severity in the childhood asthma management program. Am J Respir Crit Care Med. 2000 Jul;162(1):50–56. [PubMed]
  • Huang SL, Shiao G, Chou P. Association between body mass index and allergy in teenage girls in Taiwan. Clin Exp Allergy. 1999 Mar;29(3):323–329. [PubMed]
  • Rasmussen F, Lambrechtsen J, Siersted HC, Hansen HS, Hansen NC. Low physical fitness in childhood is associated with the development of asthma in young adulthood: the Odense schoolchild study. Eur Respir J. 2000 Nov;16(5):866–870. [PubMed]
  • Schachter LM, Salome CM, Peat JK, Woolcock AJ. Obesity is a risk for asthma and wheeze but not airway hyperresponsiveness. Thorax. 2001 Jan;56(1):4–8. [PMC free article] [PubMed]
  • Kaplan TA, Montana E. Exercise-induced bronchospasm in nonasthmatic obese children. Clin Pediatr (Phila) 1993 Apr;32(4):220–225. [PubMed]
  • del Río-Navarro B, Cisneros-Rivero M, Berber-Eslava A, Espínola-Reyna G, Sienra-Monge J. Exercise induced bronchospasm in asthmatic and non-asthmatic obese children. Allergol Immunopathol (Madr) 2000 Jan-Feb;28(1):5–11. [PubMed]
  • Becklake MR, Kauffmann F. Gender differences in airway behaviour over the human life span. Thorax. 1999 Dec;54(12):1119–1138. [PMC free article] [PubMed]
  • de Marco R, Locatelli F, Sunyer J, Burney P. Differences in incidence of reported asthma related to age in men and women. A retrospective analysis of the data of the European Respiratory Health Survey. Am J Respir Crit Care Med. 2000 Jul;162(1):68–74. [PubMed]
  • Wang X, Dockery DW, Wypij D, Fay ME, Ferris BG., Jr Pulmonary function between 6 and 18 years of age. Pediatr Pulmonol. 1993 Feb;15(2):75–88. [PubMed]
  • Rosenthal M, Cramer D, Bain SH, Denison D, Bush A, Warner JO. Lung function in white children aged 4 to 19 years: II--Single breath analysis and plethysmography. Thorax. 1993 Aug;48(8):803–808. [PMC free article] [PubMed]
  • Pistelli R, Brancato G, Forastiere F, Michelozzi P, Corbo GM, Agabiti N, Ciappi G, Perucci CA. Population values of lung volumes and flows in children: effect of sex, body mass and respiratory conditions. Eur Respir J. 1992 Apr;5(4):463–470. [PubMed]
  • Luder E, Melnik TA, DiMaio M. Association of being overweight with greater asthma symptoms in inner city black and Hispanic children. J Pediatr. 1998 Apr;132(4):699–703. [PubMed]
  • Belamarich PF, Luder E, Kattan M, Mitchell H, Islam S, Lynn H, Crain EF. Do obese inner-city children with asthma have more symptoms than nonobese children with asthma? Pediatrics. 2000 Dec;106(6):1436–1441. [PubMed]
  • Sangi H, Mueller WH. Which measure of body fat distribution is best for epidemiologic research among adolescents? Am J Epidemiol. 1991 May 1;133(9):870–883. [PubMed]
  • Cook Deborah, Rocker Graeme, Marshall John, Sjokvist Peter, Dodek Peter, Griffith Lauren, Freitag Andreas, Varon Joseph, Bradley Christine, Levy Mitchell, et al. Withdrawal of mechanical ventilation in anticipation of death in the intensive care unit. N Engl J Med. 2003 Sep 18;349(12):1123–1132. [PubMed]

Articles from Thorax are provided here courtesy of BMJ Publishing Group