Esra ÖZEK, Haluk ÇOKUĞRAŞ, Yıldız CAMCIOĞLU, Necla AKÇAKAYA

Çocukluk Çağı Astımında Obezite ve İnsülin Direncinin Astım Kontrolüne Etkisi

Amaç: Son yıllarda dünyada ve Türkiye’de hem obezite hem de çocukluk çağı astım ve alerjik hastalıkların sıklığı giderek artmaktadır. Obezite ve insülin direnci enflamasyonun arttığı bir durumdur, astım için bir risk oluşturabilir ve astım kontrolüne etki edebilir. Bu çalışmada astım nedeniyle takip edilen ve vücut kitle indeksine göre gruplandırılan hastalarda obezite ve insülin direncinin astım kontrolü, ilaç gereksinimi ve yaşam kalitesi üzerine etkisinin araştırılması amaçlandı. Gereç ve Yöntem: En az bir yıldır astım tanısıyla takip edilen 7-18 yaş arası hastalar çalışmaya alındı. Hastalar vücut kitle indeksi persantiline göre obez, kilolu, normal kilolu olarak ayrıca HOMA-IR değerine göre insülin direnci açısından gruplandırıldı. Demografik özellikler ve laboratuvar sonuçları hasta dosyalarından elde edildi. Hastaların açlık glukoz, insülin, HOMA-IR, astım kontrol anketi, yaşam kalitesi anketi, kısa etkili β2 mimetik ihtiyacı, astım atak sayısı, acile başvuru gruplar arasında karşılaştırıldı. Bulgular: Çalısmaya 90’ı erkek 149 hasta alındı. Hastalın 25’ i obez 69’u kilolu olarak değerlendirildi. Astımlı obez hastaların astım kontrol anketi puanları, yaşam kalite anketi puanları astımlı normal kilolu olgulara göre daha düşük bulundu (p=0,038, p=0,050). Hastaların 59’unda insülin direnci saptandı. İnsülin direnci varlığına göre gruplandırılarak incelendiklerinde demografik özellikler, solunum fonksiyon testleri, deri delme test sonucu, astım kontrolü, yaşam kalitesi, astım şiddeti açısından anlamlı fark bulunmadı (p>0,05). Sonuç: Astımlı obez çocuklar daha fazla semptomatik, yaşam kalitesini daha fazla bozan, astım kontrolünün daha zor olduğu bir astım fenotipine sahip olabilirler bu nedenle ayrıcalıklı bir takibe ihtiyaç duyabilirler ve ilaç gereksinimleri farklılık gösterebilir.

Anahtar Kelimeler:

astım, astım kontrolü, insülin direnci, HOMA IR, obezite, PAQLQ

The Effect of Obesity and Insulin Resistance on Asthma Control in Asthmatic Children

Objective: In recent years, the prevalence of both obesity and asthma has increased in the pediatric population in Turkey and the whole world. Obesity and insulin resistance are conditions where inflammation increases and this may pose a risk for asthma and affect asthma control. The aim of this study was to investigate the effects of obesity and insulin resistance on asthma control, medication requirements, and the quality of life in patients who were followed up for asthma and classified according to body mass index. Material and Method: Patients aged 7-18 years who had been followed up for at least one year after a diagnosis of asthma were included in the study. Patients were categorised as being obese, overweight, or normal weight according to body mass index percentile, and insulin resistance according to HOMA-IR value. Demographic characteristics and laboratory test results were obtained from patient medical records. Fasting glucose, insulin, HOMA-IR, asthma control questionnaire, pediatric asthma quality of life questionnaire, short-acting β2 mimetic drug usage, asthma attack number, and admission to emergency service were compared between the groups. Results: One hundred and fourty-nine patients (90 male, 59 female) participated in the study. 25 of the patients were classed as obese and 69 as overweight. The asthma control questionnaire scores and the quality of life questionnaire scores of the obese patients with asthma were found to be lower than the normal weight asthmatic patients (p = 0.038, p = 0.050). Insulin resistance was detected in 59 patients. When asthmatic children were grouped according to the presence of insulin resistance, no significant differences were found in terms of demographic characteristics, respiratory function tests, skin puncture test results, asthma control, quality of life, and asthma severity (p>0.05). Conclusion: Obese asthmatic children may have an asthma phenotype that is more symptomatic and more difficult to control. These patients have a more impaired quality of life, so they may need a privileged followup and medication requirements may differ.

Keywords:

Asthma, asthma control, HOMA-IR, insulin resistance, obesity, PAQLQ,

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