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Severe Asthma Research - November 2016

Christina E Ciaccio, MD, MSc

Christina E Ciaccio, MD, MSc
Allergist/Immunologist
Assistant Professor of Pediatrics
University of Chicago Medicine
Comer Children’s Hospital
Chicago, Illinois, United States

Asthma phenotypes in inner-city children

Asthma is a heterogeneous disease with significant morbidity. In the United States, children living in low-income urban regions have particularly high severity. This cluster analysis performed as part of the Asthma Consortium Asthma Phenotypes in the Inner city (APIC) study aimed to determine specific asthma phenotypes in this high-risk population. This prospective, multi-center study included school-aged children from nine U.S. cities.  Participants were characterized using 50 variables, including demographics, family history, allergy history, severity, and sensitization, asthma history and severity, BMI, vitamin D levels, environmental exposures, stress, inflammatory markers, and spirometric values. Six hundred sixteen participants were included in the cluster analysis (86% of those enrolled in APIC). Cluster analysis revealed five distinct phenotypes of asthma. Cluster A (14.9% of cohort) had minimally symptomatic asthma and rhinitis, normal pulmonary physiology and the lowest levels of allergy and allergic inflammation. Only 13% required oral corticosteroids for treatment of exacerbation over the course of the year they were followed. Cluster B (15.5% of cohort) had low levels of allergy and allergic inflammation but highly symptomatic asthma. These children had mildly impaired pulmonary physiology and 47% required oral corticosteroids for exacerbation during the year they were followed. Cluster C (23.9% of cohort) had minimally symptomatic asthma and rhinitis with an intermediate degree of allergy and allergic inflammation. These children had minimally impaired pulmonary physiology and 20% required treatment with oral corticosteroid during the year. Cluster D (30.4% of cohort) had asthma which was well controlled on intermediate step asthma treatment but had symptomatic rhinitis with high levels of allergy and allergic inflammation and an intermediate degree of pulmonary impairment. This group had a relatively high rate of asthma exacerbation over the year (36%). Cluster E (15.7% of cohort) had the highest level of symptomatic asthma and rhinitis despite the highest level of treatment and the highest degree of allergy and allergic inflammation. They had the most impaired pulmonary physiology and 75% required oral steroids of exacerbation. These results demonstrate that most asthma in this population worsened in parallel to allergy and allergic inflammation and provides a basis for a personalized approach to the treatment of asthma.

Zoratti EM, Krouse RZ, Babineau DC, Pongracic JA, O'Connor GT et al. Asthma phenotypes in inter-city children. Journal of Asthma and Clinical Immunology 2016; 138(4): 1016-1029. (doi:10.1016/j.jaci.2016.06.061)

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