Closing the dosing knowledge gap for children with asthma and obesity

Children with obesity and asthma can experience poorer symptom control, more frequent exacerbations and more difficult recoveries. Yet when these patients need corticosteroids to reduce inflammation during an asthma exacerbation, clinicians face an important challenge: There are limited dosing guidelines specific to children with obesity.

Kathryn (Kate) Kyler, MD, MSc, FAAP, Hospital Medicine, Clinical Pharmacology, Toxicology and Therapeutic Innovation at Children’s Mercy, is working to help close that gap.

Dr. Kyler’s research examines how obesity affects the way children with asthma process and respond to medications, with a particular focus on corticosteroids. Her goal is to better understand the pharmacokinetics and pharmacodynamics of these medications in children with obesity and ultimately provide evidence that can inform more precise dosing recommendations.

Asking questions that can improve care

Dr. Kyler first became interested in the issue while caring for hospitalized children. She came to Children’s Mercy in 2016 as a Pediatric Hospital Medicine fellow and later became a pediatric hospitalist.

At the bedside, she began questioning whether commonly used medications were working the same way for children with obesity, particularly when clear dosing guidance was lacking.

She pursued training in Pediatric Clinical Pharmacology from 2022 to 2024 to begin answering those questions.

Today, her research focuses on a population that can be particularly challenging to treat. Children with obesity may experience worse asthma outcomes, including poorer symptom control and a greater likelihood of asthma exacerbations followed by difficult recoveries.

Corticosteroids remain an important treatment for reducing inflammation during an exacerbation, but Dr. Kyler is examining whether current dosing approaches adequately account for the physiological differences associated with obesity.

Building evidence for more precise pediatric dosing

Dr. Kyler’s work has been supported by internal and external research funding, including two National Institutes of Health awards: a KL2 Mentored Career Development Award from the National Center for Advancing Translational Sciences through a Frontiers Clinical and Translational Science Institute subaward, and a K23 grant from the National Heart, Lung, and Blood Institute.

Her K23-supported research builds on the earlier KL2 study, with a deeper investigation of the pharmacokinetics and pharmacodynamics of corticosteroids in children with asthma and obesity.

The long-term objective is clinically practical: generate evidence that can support dosing recommendations specifically for children with obesity.

With more precise dosing information, clinicians may ultimately be better equipped to prescribe an amount of medication that effectively reduces inflammation and supports recovery while minimizing potential adverse effects.

“It might be years down the line before my research is really going to impact patients, but I'm hopeful that I'll be able to improve the safety and efficacy of medications that we're prescribing to kids with obesity,” Dr. Kyler said.

Advancing precision therapeutics

Dr. Kyler is also a member of the Precision Therapeutics and Pediatric Obesity Research Group at Children’s Mercy Research Institute, where clinicians and investigators collaborate to better understand how individual patient factors can influence treatment.

Her work represents a broader effort to address an important challenge in pediatric medicine: ensuring medication dosing evidence reflects the children clinicians are treating every day.