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  • Clinical Research Article
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Associations of meteorological factors and obesity on pediatric asthma hospitalization

Pediatric Research (2025)Cite this article

Abstract

Background

Meteorological factors and obesity are linked to pediatric asthma exacerbations, but it remains unclear whether overweight/ obese children are more vulnerable to these meteorological stressors. This study examined the associations of meteorological factors and obesity on pediatric asthma hospitalization.

Methods

This case-control study included 6956 pediatric asthma patients, with 1060 cases (at least one asthma-related hospitalization), and 5896 controls (no hospitalizations). Individual exposures to relative humidity (RH) and temperature were estimated using radial basis function interpolation at 1-day, 7-day, and 1-month intervals. Logistic regression models evaluated the associations between meteorological conditions and hospitalization, while also analyzing interactions with body weight (normal versus overweight/obese).

Results

A 1% increase in 1-month mean RH was associated with 8% decrease in the odds ratio (OR) for hospitalization (OR: 0.92, 95% CI: 0.87–0.99). Higher mean temperature, together with overweight/obesity, was associated with increased ORs for hospitalization: 42% (OR: 1.42, 95% CI: 1.04–1.93) over 1 day, 39% (OR: 1.39, 95% CI: 1.01–1.94) over 7 days, and 44% (OR: 1.44, 95% CI: 1.01–2.03) over 1 month.

Conclusion

Higher RH was protective against hospitalization, whereas elevated temperatures with overweight/obesity increased hospitalization. These findings indicate that meteorological conditions with body weight are important considerations in pediatric asthma management.

Impact

  • Higher mean temperature, together with overweight or obesity, was associated with an increased odds ratio for hospitalization compared to the normal-weight group.

  • It provides new evidence that asthmatic children with overweight or obesity are more susceptible to environmental stressors than normal-weight group.

  • This study highlights the need to consider both body weight and meteorological factors, specifically temperature and humidity, in pediatric asthma management.

Category of study: Clinical study

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Fig. 1: Flowchart of study subjects.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Vos, T. et al. Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 396, 1204–1222 (2020).

    Article  Google Scholar 

  2. Martin, J., Townshend, J. & Brodlie, M. Diagnosis and management of asthma in children. BMJ Paediatr. Open 6, e001277 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  3. Sullivan, P. W. et al. The national cost of asthma among school-aged children in the United States. Ann. Allergy Asthma Immunol. 119, 246–252.e241 (2017).

    Article  PubMed  Google Scholar 

  4. Lv, J.-J. et al. Global, regional and national epidemiology of allergic disorders in children from 1990 to 2019: findings from the Global Burden of Disease study 2019. BMJ Open 14, e080612 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  5. Zhou, W. & Tang, J. Prevalence and risk factors for childhood asthma: a systematic review and meta-analysis. BMC Pediatr. 25, 50 (2025).

    Article  PubMed  PubMed Central  Google Scholar 

  6. Zhou, X., Sampath, V. & Nadeau, K. C. Effect of air pollution on asthma. Ann. Allergy Asthma Immunol. 132, 426–432 (2024).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Ogden, C. L. et al. Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA 315, 2292–2299 (2016).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Hu, K. & Staiano, A. E. Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatr. 176, 1037–1039 (2022).

    Article  PubMed  PubMed Central  Google Scholar 

  9. Luthe, S. K. et al. Association between obesity and acute severity among patients hospitalized for asthma exacerbation. J. Allergy Clin. Immunol. Pract. 6, 1936–1941.e1934 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  10. Speakman, J. R. Obesity and thermoregulation. Handb. Clin. Neurol. 156, 431–443 (2018).

    Article  PubMed  Google Scholar 

  11. Zhang, Y., Yang, J., Chen, S., Zhang, M. & Zhang, J. Effects of meteorological factors on asthma hospital visits in Haikou City, China. Atmosphere 15, 328 (2024).

    Article  CAS  Google Scholar 

  12. Hu, Y. et al. Season-stratified effects of meteorological factors on childhood asthma in Shanghai, China. Environ. Res. 191, 110115 (2020).

    Article  CAS  PubMed  Google Scholar 

  13. di Palmo, E. et al. Childhood obesity and respiratory diseases: which link? Children 8, 177 (2021).

    Article  PubMed  PubMed Central  Google Scholar 

  14. Nguyen, P.-A. et al. Taipei Medical University Clinical Research Database: a collaborative hospital EHR database aligned with international common data standards. BMJ Health Care Inform. 31, e100890 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

  15. Bateman, E. D. et al. Global strategy for asthma management and prevention: GINA executive summary. Eur. Respir. J. 31, 143–178 (2007).

    Article  Google Scholar 

  16. Lang, J. E. et al. Being overweight or obese and the development of asthma. Pediatrics 142, e20182119 (2018).

  17. Black, M. H., Zhou, H., Takayanagi, M., Jacobsen, S. J. & Koebnick, C. Increased asthma risk and asthma-related health care complications associated with childhood obesity. Am. J. Epidemiol. 178, 1120–1128 (2013).

    Article  PubMed  PubMed Central  Google Scholar 

  18. Scholtens, S. et al. Overweight and changes in weight status during childhood in relation to asthma symptoms at 8 years of age. J. Allergy Clin. Immunol. 123, 1312–1318.e1312 (2009).

    Article  PubMed  Google Scholar 

  19. Bai, K.-J. et al. Ambient relative humidity-dependent obstructive sleep apnea severity in cold season: a case-control study. Sci. Total Environ. 861, 160586 (2023).

    Article  CAS  PubMed  Google Scholar 

  20. Romaszko-Wojtowicz, A., Dragańska, E., Doboszyńska, A. & Glińska-Lewczuk, K. Impact of seasonal biometeorological conditions and particulate matter on asthma and COPD hospital admissions. Sci. Rep. 15, 450 (2025).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  21. Zhang, Y. et al. Effects of meteorological factors on daily hospital admissions for asthma in adults: a time-series analysis. PLoS ONE 9, e102475 (2014).

    Article  PubMed  PubMed Central  Google Scholar 

  22. Tran, H. M. et al. Short-term mediating effects of PM2. 5 on climate-associated COPD severity. Sci. Total Environ. 903, 166523 (2023).

    Article  CAS  PubMed  Google Scholar 

  23. Tsai, D.-H. et al. Short-term increase in particulate matter blunts nocturnal blood pressure dipping and daytime urinary sodium excretion. Hypertension 60, 1061–1069 (2012).

    Article  CAS  PubMed  Google Scholar 

  24. Knol, M. J. & VanderWeele, T. J. Recommendations for presenting analyses of effect modification and interaction. Int. J. Epidemiol. 41, 514–520 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  25. Knol, M. J. et al. Estimating measures of interaction on an additive scale for preventive exposures. Eur. J. Epidemiol. 26, 433–438 (2011).

    Article  PubMed  PubMed Central  Google Scholar 

  26. Vatcheva, K. P., Lee, M., McCormick, J. B. & Rahbar, M. H. Multicollinearity in regression analyses conducted in epidemiologic studies. Epidemiology 6, 227 (2016).

    PubMed  Google Scholar 

  27. Lam, H. C.-Y., Li, A. M., Chan, E. Y. -y & Goggins, W. B. The short-term association between asthma hospitalisations, ambient temperature, other meteorological factors and air pollutants in Hong Kong: a time-series study. Thorax 71, 1097–1109 (2016).

    Article  PubMed  Google Scholar 

  28. Strauss, R. H., McFadden, E., Ingram, R., Deal, E. & Jaeger, J. Influence of heat and humidity on the airway obstruction induced by exercise in asthma. J. Clin. Investig. 61, 433–440 (1978).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  29. Tse, S. M., Sambahke, S., Sajedi, M., Gravel, J. & Osmanlliu, E. Higher temperatures are associated with increased asthma-related emergency department visits among children: a time series analysis of environmental exposures in Montreal, Canada. Air Qual. Atmos. Health 17, 2859–2865 (2024).

    Article  CAS  Google Scholar 

  30. Aragona, E. et al. Impact of obesity on clinical outcomes in urban children hospitalized for status asthmaticus. Hospital Pediatr. 6, 211–218 (2016).

    Article  Google Scholar 

  31. Kuo, N.-W., Tung, K.-Y., Tsai, C.-H., Chen, Y.-C. & Lee, Y. L. β3-Adrenergic receptor gene modifies the association between childhood obesity and asthma. J. Allergy Clin. Immunol. 134, 731–733.e733 (2014).

    Article  CAS  PubMed  Google Scholar 

  32. Murphy, A. et al. PRKCA: a positional candidate gene for body mass index and asthma. Am. J. Hum. Genet. 85, 87–96 (2009).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Di Genova, L., Penta, L., Biscarini, A., Di Cara, G. & Esposito, S. Children with obesity and asthma: which are the best options for their management? Nutrients 10, 1634 (2018).

    Article  PubMed  PubMed Central  Google Scholar 

  34. Deng, L. et al. High and low temperatures aggravate airway inflammation of asthma: evidence in a mouse model. Environ. Pollut. 256, 113433 (2020).

    Article  CAS  PubMed  Google Scholar 

  35. Hayes, D. Jr, Collins, P. B., Khosravi, M., Lin, R.-L. & Lee, L.-Y. Bronchoconstriction triggered by breathing hot humid air in patients with asthma: role of cholinergic reflex. Am. J. Respir. Crit. Care Med. 185, 1190–1196 (2012).

    Article  PubMed  PubMed Central  Google Scholar 

  36. Smith, C. J. Pediatric thermoregulation: considerations in the face of global climate change. Nutrients 11, 2010 (2019).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Corkey, B. E. Reactive oxygen species: role in obesity and mitochondrial energy efficiency. Philos. Trans. R. Soc. Lond. B Biol. Sci. 378, 20220210 (2023).

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  38. Belhadj Slimen, I. et al. Reactive oxygen species, heat stress and oxidative-induced mitochondrial damage. A review. Int. J. Hyperth. 30, 513–523 (2014).

    Article  CAS  Google Scholar 

  39. Teach, S. J. et al. Seasonal risk factors for asthma exacerbations among inner-city children. J. Allergy Clin. Immunol. 135, 1465–1473.e1465 (2015).

    Article  PubMed  PubMed Central  Google Scholar 

  40. Tang, J., Lai, F., Wong, F. & Hon, K. Incidence of common respiratory viral infections related to climate factors in hospitalized children in Hong Kong. Epidemiol. Infect. 138, 226–235 (2010).

    Article  CAS  PubMed  Google Scholar 

  41. Yu, J. et al. The correlation between daily temperature, diurnal temperature range, and asthma hospital admissions in Lanzhou city, 2013–2020. BMC Public Health 24, 2454 (2024).

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

This research was funded by the National Science and Technology Council of Taiwan (112-2628-B-038-010-MY3) and Taipei Medical University-Wan Fang Hospital (112TMU-WFH-07 and 113TMU-WFH-21).

Author information

Author notes

  1. These authors contributed equally: Xuan Ngoc Tran, Yueh-Lun Lee.

Authors and Affiliations

  1. International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Xuan Ngoc Tran

  2. Department of Microbiology and Immunology, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Yueh-Lun Lee

  3. Department of Civil Engineering, National Central University, Taoyuan City, Taiwan

    Yuan-Chien Lin

  4. Department of Occupational Safety and Health, College of Public Health, China Medical University, Taichung, Taiwan

    Ta-Yuan Chang

  5. Department of Environmental Engineering and Science, Feng Chia University, Taichung, Taiwan

    Li-Te Chang

  6. The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Ma Liu Shui, Hong Kong

    Kin-Fai Ho

  7. Department of Public Health, School of Medicine, Taipei Medical University, Taipei, Taiwan

    Kai-Jen Chuang

  8. School of Public Health, College of Public Health, Taipei Medical University, Taipei, Taiwan

    Kai-Jen Chuang & Hsiao-Chi Chuang

  9. National Heart and Lung Institute, Imperial College London, London, UK

    Kian Fan Chung

  10. School of Respiratory Therapy, College of Medicine, Taipei Medical University, Taipei, Taiwan

    Jer-Hwa Chang & Hsiao-Chi Chuang

  11. Division of Pulmonary Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Jer-Hwa Chang

  12. Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Hsiao-Chi Chuang

  13. Cell Physiology and Molecular Image Research Center, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan

    Hsiao-Chi Chuang

Authors
  1. Xuan Ngoc Tran
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Contributions

Xuan Ngoc Tran: Writing—review & editing, Writing—original draft, Formal analysis, Conceptualization. Yueh-Lun Lee: Writing—review & editing, Data curation, Formal analysis, Conceptualization. Yuan-Chien Lin: Writing—review & editing, Data curation. Ta-Yuan Chang: Writing—review & editing. Li-Te Chang: Writing—review & editing. Kin-Fai Ho: Writing—review & editing. Kai-Jen Chuang: Writing—review & editing. Kian Fan Chung: Writing—review & editing. Supervision. Jer-Hwa Chang: Writing—review & editing, Writing—original draft, Formal analysis, Conceptualization. Hsiao-Chi Chuang: Writing—review & editing, Writing—original draft, Formal analysis, Conceptualization.

Corresponding authors

Correspondence to Jer-Hwa Chang or Hsiao-Chi Chuang.

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Tran, X.N., Lee, YL., Lin, YC. et al. Associations of meteorological factors and obesity on pediatric asthma hospitalization. Pediatr Res (2025). https://doi.org/10.1038/s41390-025-04500-4

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  • DOI: https://doi.org/10.1038/s41390-025-04500-4

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