Asthma In African American Children Research Articles

Nasal DNA methylation differentiates severe from non-severe asthma in African-American children.

Asthma is highly heterogeneous, and severity evaluation is key to asthma management. DNA methylation (DNAm) contributes to asthma pathogenesis. This study aimed to identify nasal epithelial DNAm differences between severe and nonsevere asthmatic children and evaluate the impact of environmental exposures. Thirty-three nonsevere and 22 severe asthmatic African American children were included in an epigenome-wide association study. Genome-wide nasal epithelial DNAm and gene expression were measured. CpG sites associated with asthma severity and environmental exposures and predictive of severe asthma were identified. DNAm was correlated with gene expression. Enrichment for transcription factor (TF) binding sites or histone modifications surrounding DNAm differences were determined. We identified 816 differentially methylated CpG positions (DMPs) and 10 differentially methylated regions (DMRs) associated with asthma severity. Three DMPs exhibited discriminatory ability for severe asthma. Intriguingly, six DMPs were simultaneously associated with asthma, allergic asthma, total IgE, environmental IgE, and FeNO in an independent cohort of children. Twenty-seven DMPs were associated with traffic-related air pollution or secondhand smoke. DNAm at 22 DMPs was altered by diesel particles or allergen in human bronchial epithelial cells. DNAm levels at 39 DMPs were correlated with mRNA expression. Proximal to 816 DMPs, three histone marks and several TFs involved in asthma pathogenesis were enriched. Significant differences in nasal epithelial DNAm were observed between nonsevere and severe asthma in African American children, a subset of which may be useful to predict disease severity. These CpG sites are subjected to the influences of environmental exposures and may regulate gene expression.

Characterization of the impact of Stress Exposure on Asthma in African American Children

Characterization of the impact of Stress Exposure on Asthma in African American Children

Assessing asthma in African American children using the Asthma Control Test and the Childhood Asthma Control Test

African Americans disproportionally experience uncontrolled asthma. [1] US Department of Health and Human Services, Office of Minority HealthAsthma and African Americans. US Dept of Health and Human Services, Washington, DCAugust 2012http://minorityhealth.hhs.gov/templates/content.aspx?ID=6170 Google Scholar Because asthma control is now the focus of asthma management, [2] US Department of Health and Human Resources, National Institutes of Health, The National Heart Lung and Blood Institute, and the National Asthma Education and Prevention ProgramExpert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. US Dept of Health and Human Resources, Washington, DC2007 Google Scholar publicly available questionnaires, such as the Asthma Control Test (ACT) [3] Asthma Control Test (ACT). Quality Metric 2014. http://www.qualitymetric.com/WhatWeDo/DiseasespecificHealthSurveys/AsthmaControlTestACT/tabid/190/Default.aspx. Accessed June 19, 2014. Google Scholar and the Childhood Asthma Control Test (C-ACT), [4] Childhood Asthma Control Test. GlaxoSmithKline 2005. http://www.michaelaye.com/actchild.pdf. Accessed June 19, 2014. Google Scholar represent the most accessible, standardized, nonphysician methods of assessing control and are typically considered cost-effective and easily implemented asthma care strategies for primary care offices. Both the ACT (for those 12 years or older) and the C-ACT (for those younger than 12 years) query asthma symptoms during the past 4 weeks and use a cut point of 19 or less for not well-controlled asthma. 3 Asthma Control Test (ACT). Quality Metric 2014. http://www.qualitymetric.com/WhatWeDo/DiseasespecificHealthSurveys/AsthmaControlTestACT/tabid/190/Default.aspx. Accessed June 19, 2014. Google Scholar , 4 Childhood Asthma Control Test. GlaxoSmithKline 2005. http://www.michaelaye.com/actchild.pdf. Accessed June 19, 2014. Google Scholar Because neither questionnaire has been validated in African American children, 5 Cloutier M.M. Schatz M. Castro M. et al. Asthma outcomes: composite scores of asthma control. J Allergy Clin Immunol. 2012; 129: S24-S33 Abstract Full Text Full Text PDF PubMed Scopus (161) Google Scholar , 6 Schatz M. Sorkness C.A. Li J.T. et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J Allergy Clin Immunol. 2006; 117: 549-556 Abstract Full Text Full Text PDF PubMed Scopus (867) Google Scholar , 7 Thomas M. Kay S. Pike J. et al. The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Prim Care Respir J. 2009; 18: 41-49 Crossref PubMed Scopus (215) Google Scholar , 8 Liu A.H. Zeiger R.S. Sorkness C.A. et al. Development and cross-sectional validation of the Childhood Asthma Control Test. J Allergy Clin Immunol. 2007; 119: 817-825 Abstract Full Text Full Text PDF PubMed Scopus (639) Google Scholar , 9 Liu A.H. Zeiger R.S. Sorkness C.A. et al. The Childhood Asthma Control Test: retrospective determination and clinical validation of a cut point to identify children with very poorly controlled asthma. J Allergy Clin Immunol. 2010; 126: 267-273 Abstract Full Text Full Text PDF PubMed Scopus (80) Google Scholar , 10 Nathan R.A. Sorkness C.A. Kosinski M. et al. Development of the asthma control test: a survey for assessing asthma control. J Allergy Clin Immunol. 2004; 113: 59-65 Abstract Full Text Full Text PDF PubMed Scopus (1969) Google Scholar we sought to determine whether the ACT and the C-ACT are appropriate screening tools for asthma control in this population.

Improving Asthma Care for African American Children by Increasing National Asthma Guideline Adherence

Introduction Children, particularly African American children, bear a disproportionate burden of asthma and are at highest risk for associated morbidity and mortality. The under-utilization of the National Asthma Education and Prevention Program (NAEPP) guidelines across all demographics and the under use of inhaled corticosteroids (ICS) as controller therapy in these children are well-documented. The primary aim of this study was to increase health care provider (HCP) adherence to the NAEPP guidelines by means of a guideline reminder tool, the Multi-colored Simplified Asthma Guideline Reminder, consequently increasing the prescription of ICS in this population. Method This study had a pre-experimental design with descriptive analysis. Results The Multi-colored Simplified Asthma Guideline Reminder was effective in increasing HCP adherence to the NAEPP guidelines as evidenced by increased use of ICS as controller therapy. Discussion Despite the increasing prevalence and burden of asthma in African American children, the associated prescriptive use of ICS has not increased substantially in the past decade. The greatest obstacle in the scope of improving asthma outcomes is the underuse of ICS by HCPs.

Ethnicity and Skin Test Reactivity to Aeroallergens Among Asthmatic Children in Connecticut

To examine the relationship between ethnicity and sensitization to allergens among children with asthma living in urban and suburban areas of Connecticut. Cross-sectional study. A total of 791 children with mild-to-severe asthma who received their medical care in the city of Hartford. Puerto Rican ethnicity was associated with skin test reactivity (STR) to cockroach (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.7 to 6.4), STR to dust mite (OR, 1.7; 95% CI, 1.2 to 2.4), STR to mixed grass pollen (OR, 1.7; 95% CI, 1.1 to 2.7), and STR to mugwort/sage (OR, 2.4; 95% CI, 1.4 to 4.1). African-American ethnicity was associated with STR to four outdoor allergens (ie, mixed tree pollen [OR, 2.3; 95% CI, 1.3 to 3.9], mixed grass pollen [OR, 2.7; 95% CI, 1.6 to 4.8], mugwort/sage [OR, 3.1; 95% CI, 1.6 to 6.0], and ragweed [OR, 2.1; 95% CI, 1.2 to 3.8]). Among all children, STR to outdoor allergens was strongly associated with the extent of allergen sensitization. As an example, children sensitized to mixed grass pollen had 34.7 times higher odds of having at least four positive skin tests to other allergens than nonsensitized children (95% CI for OR, 15.6 to 77.0). Our findings suggest that Puerto Rican ethnicity is associated with an increased risk of sensitization to indoor and outdoor allergens among children with asthma, and that allergy skin testing should be performed more often as part of the management of asthma in African-American children and in Puerto Rican children in the United States.

Air pollution and exacerbation of asthma in African-American children in Los Angeles.

Significant increases in asthma morbidity and mortality in the United States have occurred since the 1970s, particularly among African-Americans. Exposure to various environmental factors, including air pollutants and allergens, has been suggested as a partial explanation of these trends. To examine relations between several air pollutants and asthma exacerbation in African-Americans, we recruited a panel of 138 children in central Los Angeles. We recorded daily data on respiratory symptoms and medication use for 13 weeks and examined these data in conjunction with data on ozone (O3) nitrogen dioxide (NO2), particulate matter (PM10 and PM2.5), meteorological variables, pollens, and molds. Using generalized estimating equations, we found associations between respiratory symptom occurrence and several environmental factors. For example, new episodes of cough were associated with exposure to PM10 (OR = 1.25; 95% CI = 1.12-1.39; interquartile range [IQR] = 17 microg/m3, 24-hour average), PM2.5 (OR = 1.10; 95% CI = 1.03-1.18; IQR = 30 microg/m3, 12-hour average), NO2, and the molds Cladosporium and Alternaria, but not with exposure to O3 or pollen. The factors PM10 and O3 were associated with the use of extra asthma medication. For this population several bioaerosols and air pollutants had effects that may be clinically significant.