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Racial disparities affect outcomes in childhood severe or difficult-to-treat asthma

Published online: August 29, 2018

The prevalence, severity, and burden of asthma is greater among children from racial minorities, particularly black children. Although several explanations for the racial disparities in asthma have been proposed, an in-depth assessment has not been performed. Using data from a real-world, prospective, observational study of patients with severe or difficult-to-treat asthma, the authors describe demographic, clinical, and asthma-related health outcomes in black and white children and examined whether the poorer outcomes in black children could be explained by modifiable and unmodifiable factors.    

Data for this study, which was recently published by Guilbert T, et al, in The Journal of Allergy and Clinical Immunology: In Practice, were based on a large United States (US) observational study (The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens or ‘TENOR’). Black and white children, 6-11 years of age, with high healthcare and medication use received their usual treatment. Patient and clinical data were collected initially and then every 6 months with help from parents or guardians.

Using data collected by study coordinators, validated patient-centric questionnaires, and lung function examination (spirometry), information was collected on asthma control, the frequency and severity of asthma exacerbations, medication compliance, asthma-related quality of life, and the impact of asthma on school and regular activity. Statistics were used to numerically compare results in black and white children and control for the effect of potential confounding factors.

A total of 86 black children and 262 white children were included in the analyses. The black patients were significantly more likely to be male, obese, and from a lower income stratum than white children. Additionally, the black patients were more likely to have very poorly controlled asthma, use non-inhaled (‘systemic’) corticosteroids for long periods, have poorer quality of life, and have emergency department visits. The differences between black and white children in asthma control and exacerbation severity persisted even after accounting for factors that could help explain these disparities, including socioeconomic status and underlying comorbidities.

This study comprehensively describes factors that may explain the disproportionately greater asthma burden in black children. Differences in asthma-related health outcomes in black versus white children were not explained by demographic and clinical characteristics, lending support to the growing body of evidence for the role of other factors, including genetics and pharmacogenetics, in the predisposition for severe asthma and response to certain medications. Findings support the paradigm of personalized medicine to help improve asthma-related health outcomes in patients with severe asthma, and particularly, in those patients of black race.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

Racial Disparities in Asthma-Related Health Outcomes in Children with Severe/Difficult-to-Treat Asthma
By Theresa Guilbert, Robert S. Zeiger, Tmirah Haselkorn, Ahmar Iqbal, Cynthia Alvarez, David R. Mink, Bradley E. Chipps, Stanley J. Szefler