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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
Article
  • 363 Downloads

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.

Keywords

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

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

Notes

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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