UVA Health study: Black children are at risk for severe form of asthma

A team of UVA Health Children’s asthma experts found that Black race and ethnicity was the single strongest risk factor for developing harmful inflammation responsible for “T2-high asthma.”

The findings could help identify children with the condition and get them tailored treatments sooner.

The results also support testing children with severe, difficult-to-treat asthma – regardless of their race – for high levels of T2 inflammation, the experts say.

“For decades we knew that Black children had more adverse outcomes from asthma across the U.S.,” said researcher W. Gerald Teague, a pediatric pulmonologist and asthma expert at UVA Health Children’s and the University of Virginia School of Medicine.

Previous research had attributed the adverse outcomes for Black children to environmental and social disparities.

The UVA researchers, in their study, adjusted for air quality, income and urban residence, and found that Black race “by far was the most important predictor of type 2 pattern inflammation,” Teague said.

“The results support greater awareness of poor symptom control and earlier intervention with therapies known to target type 2 inflammation in all children with asthma, with special attention to children of color,” Teague said.

Black children are much more likely to die of asthma than white children, and they are known to suffer T2 inflammation at higher rates.

Doctors had struggled to determine if race drove the disparity, or if there were other factors, such as environmental pollution or family income, that could be contributing.

The UVA research team looked at more than 450 children with either T2-high asthma and T2-low asthma. These children came from a broad geographic area of Virginia that includes both rural and urban areas, helping the researchers assess how much of a role environment might play.

The research team also looked at the development of T2-high asthma over time and found interesting correlations with age. By preschool, more than a third had developed T2-high asthma, climbing to more than half by kindergarten.

This has important implications for the care doctors provide children with difficult-to-treat asthma, the UVA experts say.

First, they recommend that physicians consider Black children at elevated risk for T2-high asthma.

Second, they suggest blood and allergen testing for any child with asthma symptoms that are difficult to manage.

“We hope this puts to rest the myth that environmental and social factors are the main drivers of asthma severity,” said Teague, of UVA’s Pediatric Asthma Center of Excellence. “The real emphasis for providers is to consider every child with asthma as unique, and to implement care plans that target the pattern of inflammation and integrate treatment with lifestyle and family expectations.”