Impact of obesity on respiratory system in children.

Abstract

Obesity is an emerging problem leading to multiple sequelae in pediatrics. Respiratory complications in obese children are the results of the accumulation of adipose tissue in several organs participating in gas exchange. These include the chest wall, abdominal wall, airways and diaphragm. The compliance of respiratory system is decreased resulting in decreased lung volume and exercise capacity. In addition, the fat that deposits along the upper airway and neck can cause upper airway obstruction and increase the risks of obstructive sleep apnea and obesity hypoventilation syndrome in these children. As the consequence of these respiratory compromises, obese children have increased risks for having hypoxemia, hypercapnia and respiratory failure, especially when they have concurrent respiratory tract infections, sedation or general anesthesia. Chronic hypoxemia, chronic hypercapnia and leptin resistance which is commonly found in obese children attenuate respiratory drive and worsen the hypoxemic and hypercapnic conditions in these children, leading to respiratory failure and cardiovascular complications. In addition, adipokines secreted from adipose tissue can induce inflammatory response in respiratory system and may be associated with the increased incidence of asthma and airway hyperresponsiveness in obese children. Appropriate nutritional and exercise training programs should be introduced to improve pulmonary function and prevent respiratory complications in these children.