Obesity-related asthma in children: mechanisms, clinical challenges, and management strategies

Childhood obesity-related asthma is a distinct and increasingly prevalent phenotype, associated with greater symptom burden, poorer disease control, frequent exacerbations, and reduced responsiveness to standard therapy. This phenotype is complex and heterogeneous, with underlying mechanisms involving airway inflammation, adipokine imbalance, metabolic dysregulation, changes in the gut microbiome, and altered respiratory mechanics. Current treatment for these children remains challenging, as they often show reduced responsiveness to standard inhaled corticosteroids. Multidisciplinary strategies including weight reduction, lifestyle interventions, and careful management of comorbidities are therefore essential. Emerging evidence suggests potential roles for metabolic drugs, biologic therapies, and microbiota-targeted interventions, although pediatric-specific data are still limited. Therefore, in this review, we summarize the epidemiology, pathogenesis, clinical features, and management of obesity-related asthma in children. We also highlight important gaps in knowledge and emphasize the need for large-scale, pediatric-focused, multicenter studies to develop effective, phenotype-specific treatment strategies for this growing and vulnerable patient population.