Meta-analysis finds ADHD linked to asthma but no causal effect in children
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Key Takeaway
Consider that ADHD and asthma may co-occur in children without a direct causal link.
This is a meta-analysis of observational and Mendelian randomization (MR) studies on the relationship between attention-deficit/hyperactivity disorder (ADHD) and asthma in children and adolescents. The scope included synthesizing evidence on association and causality using genetically predicted ADHD liabilities.
The authors synthesized observational findings showing that asthma prevalence was higher among participants with ADHD (10.2%) than those without ADHD (5.9%). The observational analysis also found ADHD was associated with higher odds of asthma, with an odds ratio of 1.64 (95% confidence interval = 1.36-1.98).
However, the MR meta-analysis did not support a causal effect of genetically predicted ADHD liability on childhood asthma. The pooled odds ratio from the MR analysis was 0.94 (95% confidence interval = 0.84-1.05, P > .05), indicating no causal effect.
The authors note that the observational data showed an association while the MR analysis did not reveal a causal connection, illustrating the complex interplay of genetic and nongenetic mechanisms. Limitations of the review were not detailed in the provided information.
Clinically, this suggests that while ADHD and asthma may co-occur in children, the relationship may not be directly causal. Practice relevance was not reported.
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View Original Abstract ↓
Observational epidemiological analysis and a meta-analysis of Mendelian randomization (MR) were used to investigate the association between attention-deficit/hyperactivity disorder (ADHD) and asthma in children and adolescents. Based on data from the 1999 to 2004 National Health and Nutrition Examination Survey (NHANES), an analysis was conducted to evaluate the association between ADHD and asthma in children and adolescents aged between 4 and 19 years. ADHD and asthma were defined based on self- or parent/guardian proxy-reported physician/health-professional diagnoses from the NHANES Medical Conditions Questionnaire. After analyzing ADHD genome-wide association study data from the Psychiatric Genomics Consortium as instrumental variables, we performed two-sample MR analyses based on genome-wide association study data from 5 studies to examine the causal relationship between genetically predicted ADHD liabilities. In addition, we summarized the results of the inverse-variance weighted method using a random-effects meta-analysis. Asthma prevalence was higher among participants with ADHD than those without ADHD (10.2% vs 5.9%). ADHD was associated with higher odds of asthma (odds ratio = 1.64, 95% confidence interval = 1.36-1.98), and the pattern of results was broadly consistent across subgroups. In contrast, the MR meta-analysis did not support a causal effect of genetically predicted ADHD liability on childhood asthma (odds ratio = 0.94, 95% confidence interval = 0.84-1.05, P > .05). According to data from the NHANES, ADHD and asthma are significantly associated in children and adolescents. A meta-analysis of the MR data did not reveal a causal connection between genetically predicted ADHD liability and childhood asthma. This paradoxical finding illustrates the complex interplay of genetic and nongenetic mechanisms in the ADHD-asthma association.
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