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Asthma and Nutrition

Online Educational Training

WIC Nutritionists & Nutrition Educators

Anita Conley, MS, RD

Ellen K. Bowser, MS,RD,LD/N,RN
This module was developed to educate you
The effects that asthma has on children’s
nutrition in the following ways:

– Medications

– Diet

– Weight
Why learn about asthma?
• Asthma is the most common chronic
condition among children1 and at least half
of children with asthma will be
symptomatic before the age of 5. 2

• Persistent asthma is a risk criteria to

qualify for WIC services. 3
1. Identify and dispel common myths about
asthma and nutrition.
2. Identify common medications prescribed to
children with asthma and drug nutrient
interactions for each.
3. State 3 hypotheses for why
overweight/obesity may worsen asthma.
4. Relate asthma and nutrition information to
WIC clients using VENA.
Asthma - Impact
• 6.7 million children or 9.1% of U.S. children
currently have asthma.4
• Children of low-income, those living in inner cities
and minorities are more likely to be affected.5
• Racial disparities6
• Puerto Rican – 21.8%
• Non-Hispanic Black – 13.6%
• Non-Hispanic White – 9.4%
• 19.7 billion – direct and indirect costs of asthma
to the U.S. economy in 20077
What is asthma?

Asthma is a disease in which blocked or

narrowed airways cause trouble breathing and
shortness of breath.
What are asthma triggers?
– Environmental Tobacco Smoke (Secondhand Smoke)
– Dust Mites
– Outdoor Air Pollution
– Cockroach Allergen
– Pets
– Mold

– Others
• Strenuous exercise, medicines, thunderstorms, high
humidity, freezing temperatures, some foods and food

additives, strong emotions that cause hyperventilation

Myth OR Fact?
All children with asthma wheeze.
Not all children with asthma
experience wheezing.
Asthma – Intermittent vs.
Intermittent Persistent
- Symptoms: - Symptoms:
 Occur < 2 days/week
 Occur >2days/week
- Treatment:
 Rescue meds - Treatment:
 Rescue meds
 Preventative meds



Prednisone Inhaled
Albuterol Corticosteroids Antiallergy
(5 day course) Corticosteroids
with LABA

Pulmicort® Singulair®
Prednisolone Symbicort®
Xopenex® Asmanex® Zyrtec ®
Orapred ODT® Flovent® Advair®
Claritin ®
Asthma and Medications –
Drug/Nutrient Interactions9

Inhaled Corticosteroids Oral Corticosteroids

• Manage severe
• Long-term control

weight gain
weight gain
Asthma and Medications –
Drug/Nutrient Interactions9
• ≥ 4 courses of oral steroids/year
– Increased risk of fracture

• ↑ number of doses, bone gained ↓

– Dose-dependent increased risk for osteopenia
• 0, 1 to 4, and ≥ 5 courses of oral

• ↑ appetite and ↓ calcium absorption
Myth OR Fact?
Drinking milk causes or worsens
mucus production.
Drinking milk does not cause or
worsen mucus production. 12
Asthma – Milk and Dairy
• Milk and dairy products are often falsely implicated in
the exacerbation of asthma symptoms.12,15

• Excluding milk and dairy products from the diet can

lead to a calcium deficiency.

• Eating and drinking dairy products will not increase

mucus production or make asthma worse.12

• Milk allergy may cause asthma-like symptoms, but

does not cause asthma.12, 15,16
Asthma – Food Allergies

• Eight most common food allergens are milk, eggs,

peanuts, tree nuts, soy, wheat, fish, and shellfish.16

• Food allergies are associated with asthma diagnosis.17

• Food-induced asthma exacerbation is unusual. 12,15

• Most children “out-grow” common food allergies.12,18

Asthma – Diet Research
Protective Factors?
– Vitamins C, E & B6
– Beta-carotene
– Folic Acid
– Lycopene
– Sodium
– Magnesium
– Omega 3 fatty acids
– Fish Oil
– Selenium
– Glutamine Powder

– Fruits
Asthma – Diet Research
Protective factors ?
• 2003 Netherlands study – PIAMA birth cohort14
– Allergic and non-allergic pregnant women followed
until their child was 3 years old.
– Food consumption data at 2 years were related to
asthma symptoms present at 3 years.
– Children had significantly less doctor-diagnosed
asthma and less asthma symptoms in the past 12
months with daily consumption of:
• Full cream milk and milk products
• Brown bread

Asthma – Diet Research
Protective factors ?
• 2007 London study25
– Assessed intake of apples, juice, bananas, and
other fruit in children 5-10 years old.
– Intake was related to asthma and asthma
– 1 daily serving of apple juice from concentrate
associated with less wheezing in the past 12
– Bananas were also slightly protective against
– More research is needed to confirm positive
Asthma and Weight
Asthma and Weight
Birth weight26

• 80,000 full-term children were followed for

10 years to determine relationship
between birth weight and childhood

• Children with the highest birth weights had

the greatest riskforofprenatal clients
ER visits for asthma.
about the risk of having high
birth weight babies with
excessive weight gain is
Asthma and Weight
Overweight & Obesity
Relationship between BMI and asthma begins in
• 2006 study27 :
– Obesity may lead to increased risk of asthma in children.
• Greater increase in BMI at 14 years had more asthma
• 2007 study28 :
– Girls with asthma were 3.6 times more likely than those
without asthma to:
• Be overweight and not drink enough milk
• 2008 study29 :
– Children were more likely to experience wheezing or asthma
• Had increased BMI and spent 5 hours or more watching TV daily
Asthma and Weight
Relationship between
Overweight/Obesity and Asthma30
Airway obstruction due to weight

Greater airway collapsibility

Contribution to airway inflammation

Asthma and Weight
• Exercise is important for children with
Many Olympic athletes have

• Medication can prevent or reduce asthma

Asthma and Weight
Quality of Life (QOL)32
• QOL scores are based on three domains of
– Emotions, activity, and symptoms

• Those with both asthma and excessive body

weight have a much lower QOL than asthma
alone or excessive body weight alone.
Asthma – Breastfeeding
The effect of breastfeeding on the development of
asthma is controversial

– “Children who are exclusively breastfed for at least the

first four months of life have a substantial reduction in
the risk of developing asthma by the age of 6 years.”19,20

– Exclusive breastfeeding for at least 3 months protects

against wheezing in early life22

– Does not appear to provide long-

term protection against allergy and asthma21
Asthma and Culture
Myth OR Fact?
Chihuahuas cure asthma.
There is no scientific evidence that
Chihuahuas cure asthma.
Asthma and Culture
• High prevalence of asthma among
Puerto Ricans and African Americans

• Ethnic beliefs impact personal asthma


• African Americans drink less milk than

Caucasians or Mexican-Americans.35
Asthma and VENA 36

• Patient centered counseling

– Cultural issues/beliefs about asthma
– Alternative therapies
• Anticipatory guidance
– BMI or weight-for-height percentile
– Calcium and Vitamin D intake
• Relevant information
– Corticosteroid use
• Nutritional risk
– Elimination of food groups such as dairy
– Asthma and medications
• Oral corticosteroids
– Asthma and diet
• Milk and mucus
• Food allergies
– Asthma and weight
• High birth weight
• Overweight and obesity
• Physical activity

– Asthma and culture

• Related to VENA
For further information or any questions please contact:

Pediatric Pulmonary Center at UF – (352) 273-8380

Ellen Bowser, MS, RD, LD/N, RN

Susan Horky, MSW , LCSW


Desiree Schnoor, MPH

Thalia Smith, MPH

Laura Guyer PhD, RD, LD/N

This project was supported in part by project T72MC0002 from the Maternal and Child Health Bureau (Title V, Social Security Act), Health Resources and Services Administration, United States Department of Health

and Human Services.
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