Obesity and the pulmonologist.

Obese children have more respiratory symptoms than their normal weight peers and respiratory related pathology increases with increasing weight. Some will need specialist assessment (box 1). Obesity produces mechanical effects on respiratory system performance. Breathlessness, wheeze, and cough are not related to increased airway responsiveness and may respond more to weight loss than bronchodilator therapy. A significant number of obese children have signs and symptoms of obstructive sleep apnoea largely related to the effect of obesity on upper airway dimensions. It seems likely that unless action is taken soon, increasing numbers of children will experience preventable respiratory morbidity as a result of nutritional obesity.