title: Asthma phenotypes in inner-city children.
abstract: Children with asthma in low-income urban areas have high morbidity. Phenotypic analysis in these children is lacking, but may identify characteristics to inform successful tailored management approaches.
  
  
  
  We sought to identify distinct asthma phenotypes among inner-city children receiving guidelines-based management.
  
  
  
  Nine inner-city asthma consortium centers enrolled 717 children aged 6 to 17 years. Data were collected at baseline and prospectively every 2 months for 1 year. Participants' asthma and rhinitis were optimally managed by study physicians on the basis of guidelines. Cluster analysis using 50 baseline and 12 longitudinal variables was performed in 616 participants completing 4 or more follow-up visits.
  
  
  
  Five clusters (designated A through E) were distinguished by indicators of asthma and rhinitis severity, pulmonary physiology, allergy (sensitization and total serum IgE), and allergic inflammation. In comparison to other clusters, cluster A was distinguished by lower allergy/inflammation, minimally symptomatic asthma and rhinitis, and normal pulmonary physiology. Cluster B had highly symptomatic asthma despite high step-level treatment, lower allergy and inflammation, and mildly altered pulmonary physiology. Cluster C had minimally symptomatic asthma and rhinitis, intermediate allergy and inflammation, and mildly impaired pulmonary physiology. Clusters D and E exhibited progressively higher asthma and rhinitis symptoms and allergy/inflammation. Cluster E had the most symptomatic asthma while receiving high step-level treatment and had the highest total serum IgE level (median, 733 kU/L), blood eosinophil count (median, 400 cells/mm3), and allergen sensitizations (15 of 22 tested).
  
  
  
  Allergy distinguishes asthma phenotypes in urban children. Severe asthma often coclusters with highly allergic children. However, a symptomatic phenotype with little allergy or allergic inflammation was identified.
authors.affiliation: Henry Ford Health System and Wayne State University School of Medicine, Detroit, Mich. Electronic address: ezoratt1@hfhs.org.
authors.forename: Edward M
authors.initials: EM
authors.lastname: Zoratti
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Rebecca Z
authors.initials: RZ
authors.lastname: Krouse
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Denise C
authors.initials: DC
authors.lastname: Babineau
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
authors.forename: Jacqueline A
authors.initials: JA
authors.lastname: Pongracic
authors.affiliation: Boston University School of Medicine, Boston, Mass.
authors.forename: George T
authors.initials: GT
authors.lastname: O'Connor
authors.affiliation: Johns Hopkins University School of Medicine, Baltimore, Md.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Wood
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Gurjit K
authors.initials: GK
authors.lastname: Khurana Hershey
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Kercsmar
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Gruchalla
authors.affiliation: College of Physicians and Surgeons, Columbia University, New York, NY.
authors.forename: Meyer
authors.initials: M
authors.lastname: Kattan
authors.affiliation: Children's National Health System and the George Washington University School of Medicine and Health Sciences, Washington, DC.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
authors.affiliation: National Institutes of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Steven M
authors.initials: SM
authors.lastname: Sigelman
authors.affiliation: National Institutes of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gergen
authors.affiliation: National Institutes of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Alkis
authors.initials: A
authors.lastname: Togias
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Cynthia M
authors.initials: CM
authors.lastname: Visness
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: William W
authors.initials: WW
authors.lastname: Busse
authors.affiliation: National Jewish Health, Denver, Colo; Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D001249:Asthma / Q000150:complications* / Q000453:epidemiology / Q000503:physiopathology* / Q000628:therapy; D002648:Child; D016000:Cluster Analysis; D016021:Epidemiologic Studies; D006801:Humans; D006967:Hypersensitivity / Q000150:complications* / Q000453:epidemiology; D010641:Phenotype; D011203:Poverty; D011446:Prospective Studies; D012220:Rhinitis / Q000145:classification / Q000150:complications / Q000453:epidemiology / Q000503:physiopathology; D012720:Severity of Illness Index; D012959:Socioeconomic Factors; D014481:United States; D014505:Urban Population
keywords: Allergen sensitization; IgE; airway inflammation; allergy; asthma phenotypes; asthma severity; bronchial hyperresponsiveness; hierarchical cluster; inner-city asthma; rhinitis