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Asthma and Its Effects on Children Who Live in Inner Cities

Multicity study identifies five different asthma phenotypes with varying degrees of disease severity and allergic features

WASHINGTON, DC – Asthma carries a distinct fingerprint for U.S. children living in low-income inner cities, according to a study published October 5 in the Journal of Allergy and Clinical Immunology that finds urban-dwelling and largely minority kids cluster into five distinct asthma phenotypes. The phenotypes include kids whose asthma carries low levels of allergy and inflammation and minimal symptoms to kids who have high severity and worsened symptoms even while undergoing aggressive asthma treatment.

The new research insights ultimately will help to personalize asthma prevention and treatment for inner city youths who are disproportionately affected by severe asthma, says study co-author Stephen J. Teach, MD, MPH, Director and Principal Investigator of IMPACT DC, a care, research, and advocacy program focused on under-resourced and largely minority children with asthma. “The more that we’re able to describe an individual child’s clinical picture, the more we can - in our minds - drop him or her into these categories, the more personalized and targeted the therapy can become,” Dr. Teach says.

“We are just beginning to understand the complex interplay between numerous factors that influence pediatric asthma,” he adds. “We know for sure that many exacerbations of asthma occur among children who are sensitized and exposed to allergens like dust, mold, cats, dogs, mice, and cockroaches and then catch a cold through a common virus, like rhinovirus. The situation is made much worse by irritants like tobacco smoke. We are developing therapies targeting each of these predisposing factors.”

According to the Centers for Disease Control and Prevention, 8.6 percent of children across the nation, or 6.3 million kids, have asthma, and each emergency department visit is associated with 10 to 15 missed school days. In the District of Columbia, a disproportionately higher number of disadvantaged and minority children suffer from the respiratory ailment.

Despite these sobering statistics, little is known about the unique challenges faced by inner city youths with moderate-to-severe asthma, the phenotypes that apply to many of these at-risk kids, and whether any given phenotype responds best to a specific array of treatments. To address these research gaps, the Inner-City Asthma Consortium conducted the study, enrolling 717 kids aged 6 to 17 with asthma who live in low-income areas of Baltimore, Boston, Chicago, Cincinnati, Dallas, Denver, Detroit, New York City, and Washington, DC. Among the findings:

  • Even when kids take their medications regularly, those with difficult-to-control asthma – characterized by high exacerbations, especially in the spring and fall – showed little improvement in their symptoms.
  • For many kids, allergy follows a familiar “pathway” that links the individual domains of sensitization to the allergen, inflammatory response, the physiology of the lungs, and rhinitis severity to the severity of the asthma itself. Both rhinitis – inflamed nasal passages – and exposure to secondhand tobacco smoke can exacerbate asthma severity. A greater recognition of the relative contributions of each domain could be used to prioritize interventions to reduce asthma severity.
  • When it comes to asthma phenotypes, there is a linkage between severe asthma and highly allergic children. Curiously, kids can still experience symptoms in the absence of allergy or allergic inflammation.

“Like all great research, our recent studies have generated more questions than they have answered, but we now understand better than ever that all children with asthma are not the same. Individual kids fit individual unique patterns that must be approached with personalized therapy,” Dr. Teach says.

Related Video: Asthma Phenotypes in Inner-City Children

Contact: Diedtra Henderson | Children’s National Health System | c: 443-610-9826/o: 202-476-4500 |

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