A University of Virginia study found that Black children with severe asthma are nearly three to four times more likely to experience T2HIGH asthma, a high-inflammatory form of the disease, even after accounting for environmental and social factors. Race emerged as the strongest predictor of this severe inflammation type, suggesting the need for more personalized and targeted treatment strategies for children of color with difficult-to-control asthma.
- Black children with severe asthma had nearly 3-4 times greater odds of experiencing T2HIGH inflammation compared to peers, even after adjusting for air quality, income and urban residence.
- T2HIGH asthma emerged as the dominant form of severe asthma by age five in the study population.
- Black children in the T2HIGH group experienced more hospital admissions and poorer lung function than T2LOW classified children.
Black children who have severe asthma are significantly more likely to experience a high-inflammatory form of the disease, known as T2HIGH asthma, even after factoring in social, environmental and clinical considerations. The findings were detailed in the paper, “Race Adjusted for Social and Environmental Disparities Is the Principal Determinant of T2HIGH Inflammation in Children With Severe Asthma,” and published in the Journal of Allergy and Clinical Immunology: In Practice.
Researchers at the University of Virginia (UVA) School of Medicine and UVA Health Children’s in Charlottesville said the revelation could help physicians better tailor treatment strategies for children with difficult-to-control asthma.
The team investigated biological and social factors associated with severe, treatment-resistant asthma in children, analyzing 451 participants who underwent advanced clinical testing, including bronchoscopy and blood assessments for type 2 (T2) inflammatory markers. Children were classified into either a T2HIGH or T2LOW inflammatory phenotype based on the presence of eosinophilic inflammation and allergic sensitization.
According to the study, the T2HIGH phenotype emerged as the dominant form of severe asthma by age five. Participants in the T2HIGH group were generally older, more likely to self-identify as Black, lived in lower-income households, experienced more hospital admissions and showed poorer lung function compared to children classified as T2LOW.
Most notably, researchers found that Black race and ethnicity were the strongest predictors of T2HIGH inflammation. After adjusting for social and environmental disparities, Black children had nearly three times greater odds of experiencing the high-inflammatory phenotype, they reported. When considering clinical outcomes, the odds increased to nearly four times greater than their peers, researchers said. Advanced neural network analyses confirmed the findings.
“For decades we knew that Black children had more adverse outcomes from asthma across the U.S. 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 researcher W. Gerald Teague, MD, a pediatric pulmonologist and asthma expert at UVA Health Children’s and the UVA School of Medicine, in a news release. “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.”
Investigators said that their results contribute to a growing body of evidence linking asthma control to race and social determinants of health, and they hope their work will support more personalized treatment strategies to address persistent disparities in pediatric asthma care.
