Jason Lang, MD

Obesity in asthma increases breathing problems and leads to limited activity. Among children with asthma, obesity is associated with a reduced response to conventional anti-asthma drugs. Pulmonary rehabilitation is a treatment cornerstone in adults but understudied in children. Inspiratory muscle ‘rehabilitation’ training (IMR) in adults improves diaphragmatic strength, reduces breathing problems and improves exercise tolerance. We found that in obese children with asthma, IMR over 6 weeks was well-tolerated, and led to improved diaphragmatic strength and exercise capacity, and a tendency for fewer asthma symptoms. We will now study whether a simple IMR intervention over 8 weeks can improve breathing outcomes in 60 children ages 8 to 17 with obesity and asthma. The study will confirm the safety, feasibility/patient enthusiasm and preliminary efficacy of a novel non-drug intervention. The findings may provide a valuable new management tool for children struggling with obesity and asthma. 

Update:
We are beginning to enroll patients. Comprehensive testing (inspiratory muscle function, lung function, asthma symptoms, dyspnea scores that rate breathing problems, and exercise capacity) will be completed at 0 and 8 weeks. Our central hypothesis is that obesity promotes breathing problems and activity limitation, worsens validated asthma scores via ‘non-asthma’ mechanisms such as chest restriction and inspiratory muscle weakness, and a simple IMR training regimen will be safe, feasible, and improve respiratory health.  Our study will evaluate the acceptability of IMR in children with obesity and asthma, and look for changes in inspiratory muscle function with IMR.  We will also evaluate changes in respiratory symptoms following IMR.