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Inner-City Asthma in Children

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Abstract

Asthma in inner-city children is often severe and difficult to control. Residence in poor and urban areas confers increased asthma morbidity even after adjusting for ethnicity, age, and gender. Higher exposure to household pests, such as cockroaches and mice, pollutants and tobacco smoke exposure, poverty, material hardship, poor-quality housing, differences in health care quality, medication compliance, and heath care access also contribute to increased asthma morbidity in this population. Since 1991, the National Institutes of Allergy and Infectious Diseases established research networks: the National Cooperative Inner-City Asthma Study (NCICAS), the Inner-City Asthma Study (ICAS), and the Inner-City Asthma Consortium (ICAC), to improve care for this at risk population. The most striking finding of the NCICAS is the link between asthma morbidity and the high incidence of allergen sensitization and exposure, particularly cockroach. The follow-up ICAS confirmed that reductions in household cockroach and dust mite were associated with reduction in the inner-city asthma morbidity. The ICAC studies have identified that omalizumab lowered fall inner-city asthma exacerbation rate; however, the relationship between inner-city asthma vs immune system dysfunction, respiratory tract infections, prenatal environment, and inner-city environment is still being investigated. Although challenging, certain interventions for inner-city asthma children have shown promising results. These interventions include family-based interventions such as partnering families with asthma-trained social workers, providing guidelines driven asthma care as well as assured access to controller medication, home-based interventions aim at elimination of indoor allergens and tobacco smoke exposure, school-based asthma programs, and computer/web-based asthma programs.

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Abbreviations

ACE:

Asthma Control Evaluation

ACT:

Asthma Control Test

APIC:

Asthma Phenotypes in the Inner City

ASMA:

Asthma Self-Management for Adolescents

CASI:

Composite Asthma Severity Index

CDC:

Center for Disease Control

COAST:

Childhood Origins of Asthma study

CXCL 1:

C-X-C motif chemokine ligand 1

DMRs:

Differentially methylated regions

ED:

Emergency department

ETS:

Environmental tobacco smoke

FAB:

Facilitated allergen binding

FeNO:

Fractional exhaled nitric oxide

ICAC:

Inner-City Asthma Consortium

ICAS:

Inner-City Asthma Study

ICATA:

Inner-City Anti-IgE Therapy for Asthma

IFN:

Interferon

Ig:

Immunoglobulin

IL:

Interleukin

ISAAC:

International Study of Asthma and Allergies in Childhood

IT:

Immunotherapy

MAIT:

Mucosal-associated invariant T cells

NAEPP:

National Asthma Education and Prevention Program

NCICAS:

National Cooperative Inner-City Asthma Study

NHIS:

National Health Interview Survey

NHLBI:

National Heart, Lung, and Blood Institute

NIAID:

National Institutes of Allergy and Infectious Diseases

NIH:

National Institute of Health

NKT cells:

Natural killer T cells

PBMCs:

Peripheral blood mononuclear cells

PM:

Particulate matter

PROSE:

Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations

RSV:

Respiratory syncytial virus

SARP:

Severe Asthma Research Program

SAMPRO:

School-based Asthma Management Program

SICAS:

School Inner-City Asthma Study

SCIT:

Subcutaneous immunotherapy

SLIT:

Sublingual immunotherapy

Th 2:

T helper 2

Th 17:

T helper 17

URECA:

Urban Environment and Childhood Asthma Study

UC:

Urgent care

US:

United States

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  1. Division of Allergy/Immunology, Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, 3950 Beaubien, 4th Floor, Pediatric Specialty Building, Detroit, MI, 48201, USA

    Pavadee Poowuttikul & Divya Seth

  2. Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital of Michigan, Wayne State University School of Medicine, Detroit, MI, USA

    Shweta Saini

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Poowuttikul, P., Saini, S. & Seth, D. Inner-City Asthma in Children. Clinic Rev Allerg Immunol 56, 248–268 (2019). https://doi.org/10.1007/s12016-019-08728-x

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