Asthma is an incredibly variable disease with its impact on
people and molecular and cellular mechanisms what it does to the lungs and rest
of the body. This month’s issue of JACI
features three articles by Zoratti et al (J Allergy Clin Immunol 2016; 138(4): 1016-1029), Pongracic et al (J Allergy Clin Immunol 2016; 138(4): 1030-1041), and Liu et al (J Allergy Clin Immunol 2016; 138(4): 1042-1050),
covering asthma among inner city children.
They examine factors that determine the phenotype, severity and disease
control, based on data they obtained from the Asthma Phenotypes in the Inner
City (APIC) study, which looked at children aged 6 to 17 years and examined
them every 2 months for one year. Even
though their techniques are all slightly different, all three analyses determined
that allergic inflammation was a very significant contributor to disease. In addition to rhinitis, pulmonary physiology
also influenced severity and ability to control asthma despite guideline-based
therapy. Body mass index and
environmental tobacco exposure were also quite significant in explaining
severity of and ability to control disease activity, respectively. Interestingly, Vitamin D did not have a
significant effect on the control of asthma.
Altogether, the results of the APIC study provide insights into what
strategies can be implemented to bring asthma under better control in inner
cities. Identifying those who are most
at risk through the results of these studies, and targeting allergic
inflammation, both in the upper or the lower respiratory passages, may help to
reduce the burden of asthma.
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