Clinical Reviews in Allergy & Immunology

, Volume 56, Issue 2, pp 248–268 | Cite as

Inner-City Asthma in Children

  • Pavadee PoowuttikulEmail author
  • Shweta Saini
  • Divya Seth


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.


Asthma Inner-city Children Asthma Research Networks Asthma risk factors Severe asthma Asthma morbidity 



Asthma Control Evaluation


Asthma Control Test


Asthma Phenotypes in the Inner City


Asthma Self-Management for Adolescents


Composite Asthma Severity Index


Center for Disease Control


Childhood Origins of Asthma study


C-X-C motif chemokine ligand 1


Differentially methylated regions


Emergency department


Environmental tobacco smoke


Facilitated allergen binding


Fractional exhaled nitric oxide


Inner-City Asthma Consortium


Inner-City Asthma Study


Inner-City Anti-IgE Therapy for Asthma








International Study of Asthma and Allergies in Childhood




Mucosal-associated invariant T cells


National Asthma Education and Prevention Program


National Cooperative Inner-City Asthma Study


National Health Interview Survey


National Heart, Lung, and Blood Institute


National Institutes of Allergy and Infectious Diseases


National Institute of Health

NKT cells

Natural killer T cells


Peripheral blood mononuclear cells


Particulate matter


Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations


Respiratory syncytial virus


Severe Asthma Research Program


School-based Asthma Management Program


School Inner-City Asthma Study


Subcutaneous immunotherapy


Sublingual immunotherapy

Th 2

T helper 2

Th 17

T helper 17


Urban Environment and Childhood Asthma Study


Urgent care


United States


Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval and Informed Consent

This article does not contain any studies with human participants or animals performed by any of the authors. Informed consent is not applicable.


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© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Division of Allergy/Immunology, Department of Pediatrics, Children’s Hospital of MichiganWayne State University School of MedicineDetroitUSA
  2. 2.Division of Hospital Medicine, Department of Pediatrics, Children’s Hospital of MichiganWayne State University School of MedicineDetroitUSA

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