New research indicates race is the primary predictor of severe airway inflammation in pediatric patients.
RT’s Three Key Takeaways:
- Primary Risk Factor: Researchers found that race and ethnicity are the strongest predictors of severe type 2 airway inflammation, even after adjusting for household income, air quality, and urban residence.
- Early Disease Progression: High-risk inflammation develops early in childhood, affecting more than one-third of pediatric asthma patients by preschool and more than half by kindergarten.
- Targeted Clinical Testing: The findings support earlier intervention and objective testing, including blood and allergen evaluations, to guide targeted therapies for children with difficult-to-manage asthma symptoms.
Race and ethnicity are the strongest risk factors for developing harmful inflammation that drives type 2-high (T2-high) asthma in pediatric patients, according to study findings published in the Journal of Allergy and Clinical Immunology: In Practice.
Children presenting with T2-high asthma frequently experience recurrent exacerbations and exhibit symptoms that are difficult to manage with conventional therapy. Healthcare professionals and researchers have long sought to clarify the underlying drivers behind documented racial disparities in pediatric asthma mortality and disease severity across the US.
“For decades we knew that Black children had more adverse outcomes from asthma across the US. Most of the research attributed this to environmental and social disparities. We learned instead in a study that was adjusted for air quality, income and urban residence that Black race by far was the most important predictor of type 2 pattern inflammation,” said W Gerald Teague, MD, a pediatric pulmonologist and asthma expert at UVA Health Children’s and the University of Virginia School of Medicine. “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.”
Evaluating Environmental Versus Biological Factors
To evaluate whether clinical disparities stem primarily from race or from contributing external variables such as environmental pollution and family income, the research team examined more than 450 pediatric patients diagnosed with either T2-high or T2-low asthma. The study cohort was drawn from a wide geographic cross section across Virginia that included both rural and urban environments, enabling investigators to control for environmental exposure.
Following statistical adjustment for air quality metrics, household income levels, and urban residency, the investigators determined that race remained the primary predictor of elevated T2 inflammation, according to the study.
The researchers also analyzed how T2-high asthma manifests across age groups. The data revealed that more than one-third of pediatric patients developed T2-high asthma by preschool age, with that proportion rising to more than half by kindergarten.
Implications for Clinical Practice
Based on these outcomes, the study authors advised clinicians to recognize Black children as having an elevated risk profile for T2-high asthma. Additionally, the authors recommended implementing blood and allergen testing for any pediatric patient presenting with severe or difficult-to-control asthma symptoms, regardless of race, to confirm whether T2 inflammation is present.
Identifying the specific inflammatory phenotype allows clinicians to deliver targeted treatments earlier in disease progression, potentially curbing emergency department visits and improving long-term respiratory outcomes.
“We hope this puts to rest the myth that environmental and social factors are the main drivers of asthma severity,” said Teague, an asthma expert with the Pediatric Asthma Center of Excellence at UVA Health Children’s. “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.”
