Characterization of asthma exacerbations in primary care using cluster analysis

Association Between Childhood Asthma and Gastroesophageal Reflux Disease in Children: A Systematic Review

This study aims to comprehensively investigate the association between childhood asthma and gastroesophageal reflux disease (GERD) in children. A thorough search of pertinent databases was done in order to find studies that satisfied the requirements for inclusion. A thorough search of PubMed, Web of Science, SCOPUS, and Science Direct was conducted to find pertinent literature. Twelve studies, including a total of 176,678 patients - 91,447 (51.8%) of them were males - were included in our data. The prevalence of GERD in asthmatic children ranged from 0.7% to 65.3%, with a total prevalence of 3317 (3.6%). The included studies documented that GERD increases the chance of asthma, while asthma raises the risk of GERD. Obesity in asthmatic patients was an independent risk factor for the incidence of GERD. Controlling asthma is significantly impacted by comorbidities like obesity and GRED. The findings of our comprehensive review point to a possible link between juvenile patients with asthma who are referred to secondary and tertiary care facilities and having GERD. Nevertheless, the evidence for this link is weak in a number of situations. Lack of longitudinal research establishing the proper temporal sequence, studies indicating no severity-response relationship, and insufficient data showing a treatment-response relationship all contribute to the uncertainty around the nature and direction of the association. Our findings highlight the need for additional epidemiologic research to investigate the connection between GERD and asthma, including long-term follow-up.

Identification of New Clusters from Labeled Data Using Mixture Models

Nowadays attempts to segment classes or groups are often found in various fields. Especially, one of emerging issues in biological and medical areas is identification of new subtypes of biological samples or patients. For the identification, we often need to find new subtypes from known classes. In such cases, we usually use clustering techniques. However, usual clustering methods could mix up the labels of the known classes in clustering outcomes and it might lead to wrong interpretation for the identified clusters. Also, they do not use the information about known classes. Thus, this study proposes a Gaussian mixture model-based approach for identifying new clusters from known classes while it maintains them. The performance of the proposed model is verified through simulations and it is applied to a breast cancer data set.

Data-driven questionnaire-based cluster analysis of asthma in Swedish adults

The aim of this study was to identify asthma phenotypes through cluster analysis. Cluster analysis was performed using self-reported characteristics from a cohort of 1291 Swedish asthma patients. Disease burden was measured using the Asthma Control Test (ACT), the mini Asthma Quality of Life Questionnaire (mini-AQLQ), exacerbation frequency and asthma severity. Validation was performed in 748 individuals from the same geographical region. Three clusters; early onset predominantly female, adult onset predominantly female and adult onset predominantly male, were identified. Early onset predominantly female asthma had a higher burden of disease, the highest exacerbation frequency and use of inhaled corticosteroids. Adult onset predominantly male asthma had the highest mean score of ACT and mini-AQLQ, the lowest exacerbation frequency and higher proportion of subjects with mild asthma. These clusters, based on information from clinical questionnaire data, might be useful in primary care settings where the access to spirometry and biomarkers is limited.

Longitudinal outcomes of different asthma phenotypes in primary care, an observational study

While asthma presentation is heterogeneous, current asthma management guidelines in primary care are quite homogeneous. In this study we aim to cluster patients together into different phenotypes, that may aid the general practitioner in individualised asthma management. We analysed data from the ACCURATE trial, containing 611 adult asthmatics, 18-50 year-old, treated in primary care, with one year follow-up. Variables obtained at baseline (n = 14), were assessed by cluster analysis. Subsequently, established phenotypes were assessed separately on important asthma outcomes after one year follow-up: asthma control (Asthma Control Questionnaire (ACQ)), quality of life (Asthma Quality of Life Questionnaire (AQLQ)), exacerbation-rate and medication-usage. Five distinct phenotypes were identified. The first phenotype was predominantly defined by their early onset atopic form of asthma. The second phenotype mainly consisted of female patients with a late onset asthma. The third phenotype were patients with high reversibility rates after bronchodilator usage. The fourth phenotype were smokers and the final phenotype were frequent exacerbators. The exacerbators phenotype had the worst outcomes for asthma control and quality of life and experienced the highest exacerbation-rate, despite using the most medication. The early onset phenotype patients were relatively well controlled and their medication dosage was low.

ASTHMA

INDIVIDUALIZING TREATMENT BY PHENOTYPE: Asthma patients should be characterised according to their individual asthma type to ensure more targeted treatment. Even though asthma manifests itself in a wide variety of forms with differing degrees of severity, treatment of the disease often takes a broad, one-size-fits-all approach. To determine if asthma can indeed be split into distinct phenotypes, Rishi Khusial at the Leiden University Medical Center and co-workers across the Netherlands analysed data from 611 adult asthmatics treated in primary care, and followed them up after one year. The team identified five phenotypes in the primary care cohort, including one group with early onset asthma, another whose asthma responded well to bronchodilators, and a group classed as frequent exacerbators. Further analysis of long-term asthma outcomes showed clear differences between phenotypes, particularly in terms of asthma control and quality of life.

Asthma and the Risk of Rheumatoid Arthritis: An Insight into the Heterogeneity and Phenotypes of Asthma

Asthma is traditionally regarded as a chronic airway disease, and recent literature proves its heterogeneity, based on distinctive clusters or phenotypes of asthma. In defining such asthma clusters, the nature of comorbidity among patients with asthma is poorly understood, by assuming no causal relationship between asthma and other comorbid conditions, including both communicable and noncommunicable diseases. However, emerging evidence suggests that the status of asthma significantly affects the increased susceptibility of the patient to both communicable and noncommunicable diseases. Specifically, the impact of asthma on susceptibility to noncommunicable diseases such as chronic systemic inflammatory diseases (e.g., rheumatoid arthritis), may provide an important insight into asthma as a disease with systemic inflammatory features, a conceptual understanding between asthma and asthma-related comorbidity, and the potential implications on the therapeutic and preventive interventions for patients with asthma. This review discusses the currently under-recognized clinical and immunological phenotypes of asthma; specifically, a higher risk of developing a systemic inflammatory disease such as rheumatoid arthritis and their implications, on the conceptual understanding and management of asthma. Our discussion is divided into three parts: literature summary on the relationship between asthma and the risk of rheumatoid arthritis; potential mechanisms underlying the association; and implications on asthma management and research.

Determinants of longitudinal health-related quality-of-life change in children with asthma from low-income families: a report from the PROMIS® Pediatric Asthma Study

BACKGROUND

How the longitudinal asthma control status and other socio-demographic factors influence the changes of health-related quality of life (HRQOL) among asthmatic children, especially from low-income families, has not been fully investigated.

OBJECTIVES

This study aimed to describe the trajectories of asthma-specific HRQOL over 15 months and examine the effect of asthma control status on HRQOL by taking socio-demographic factors into consideration.

METHODS

A total of 229 dyads of asthmatic children and their parents enroled in public insurance programs were recruited for assessing asthma control status and HRQOL over four time points of assessment. Asthma control status was measured using the Asthma Control and Communication Instrument, and asthma-specific HRQOL was assessed using the Patient-Reported Outcomes Measurement Information System's Pediatric Asthma Impact Scale. Latent growth models (LGMs) were applied to examine the trajectory of HRQOL and the factors contributing to the changes of HRQOL.

RESULTS

Unconditional LGM revealed that HRQOL was improved over time. Conditional LGM suggested that accounting for asthma control and participants' socio-demographic factors, the variation in the initial level of HRQOL was significant, yet the rate of change was not. Conditional LGM also revealed that poorly controlled asthma status was associated with poor HRQOL at each time point (P's < 0.05). Lower parental education was associated with lower baseline HRQOL (P < 0.05). Hispanic children had a larger increase in HRQOL over time (P < 0.01) than non-Hispanic White children.

CONCLUSIONS

Vulnerable socio-demographic characteristics and poorly controlled asthma status affect HRQOL in children. This finding encourages interventions to improve asthma control status and HRQOL in minority children.

Treatment response with mepolizumab in severe eosinophilic asthma patients with previous omalizumab treatment

Background

We performed post hoc analyses to evaluate the effect of humanized monoclonal antibody mepolizumab in patients with severe eosinophilic asthma previously treated with omalizumab.

Methods

Data were collected from two randomized double‐blind, placebo‐controlled studies: MENSA (NCT01691521: 32‐week treatment phase) and SIRIUS (NCT01691508: 24‐week treatment phase). Active treatment was 75 mg intravenous mepolizumab (MENSA) or 100 mg subcutaneous mepolizumab (MENSA, SIRIUS). Patients had evidence of eosinophilic inflammation ≥150 cells/μl (at screening) or ≥300 cells/μl (during the previous year). Primary outcomes were the rate of exacerbations (MENSA) and the percentage reduction in oral corticosteroid (OCS) dose (SIRIUS). Other outcomes included lung function (forced expiratory volume in 1 s and morning peak expiratory flow), Asthma Control Questionnaire (ACQ‐5), St George's Respiratory Questionnaire (SGRQ) scores, and safety.

Results

Overall, 576 patients were included from MENSA and 135 from SIRIUS, with 13% and 33% previously receiving omalizumab, respectively. In MENSA, mepolizumab reduced the rate of exacerbations by 57% (prior omalizumab) and 47% (no prior omalizumab) vs placebo. In SIRIUS, reductions in OCS use were comparable regardless of prior omalizumab use. Despite reducing chronic OCS use, mepolizumab also resulted in similar reductions in exacerbation rate relative to placebo in both subgroups. Asthma control and quality of life improved with mepolizumab vs placebo in both studies independent of prior omalizumab use, as shown by ACQ‐5 and SGRQ scores. Adverse events were also comparable irrespective of prior omalizumab use.

Conclusions

These post hoc analyses indicate that patients with severe eosinophilic asthma respond positively to mepolizumab regardless of prior use of omalizumab.

Phenotyping of difficult asthma using longitudinal physiological and biomarker measurements reveals significant differences in stability between clusters

Background

Although the heterogeneous nature of asthma has prompted asthma phenotyping with physiological or biomarker data, these studies have been mostly cross-sectional. Longitudinal studies that assess the stability of phenotypes based on a combination of physiological, clinical and biomarker data are currently lacking.

Our objective was to assess the longitudinal stability of clusters derived from repeated measures of airway and physiological data over a 1-year period in moderate and severe asthmatics.

Methods

A total of 125 subjects, 48 with moderate asthma (MA) and 77 with severe asthma (SA) were evaluated every 3 months and monthly, respectively, over a 1-year period. At each 3-month time point, subjects were grouped into 4 asthma clusters (A, B, C, D) based on a combination of clinical (duration of asthma), physiological (FEV₁ and BMI) and biomarker (sputum eosinophil count) variables, using k-means clustering.

Results

Majority of subjects in clusters A and C had severe asthma (93 % of subjects in cluster A and 79.5 % of subjects in cluster C at baseline). Overall, a total of 59 subjects (47 %) had stable cluster membership, remaining in clusters with the same subjects at each evaluation time. Cluster A was the least stable (21 % stability) and cluster B was the most stable cluster (71 % stability). Cluster stability was not influenced by changes in the dosage of inhaled corticosteroids.

Conclusion

Asthma phenotyping based on clinical, physiologic and biomarker data identified clusters with significant differences in longitudinal stability over a 1-year period. This finding indicates that the majority of patients within stable clusters can be phenotyped with reasonable accuracy after a single measurement of lung function and sputum eosinophilia, while patients in unstable clusters will require more frequent evaluation of these variables to be properly characterized.

Cluster analysis and characterization of response to mepolizumab. A step closer to personalized medicine for patients with severe asthma

RATIONALE

Detailed characterization of asthma phenotypes is essential for identification of responder populations to allow directed personalized medical intervention.

OBJECTIVES

The aim of this study was to identify distinctive patient characteristics within subgroups of a well-characterized severe asthma population at risk for exacerbations and to determine the treatment response within each subgroup.

METHODS

A supervised cluster analysis with recursive partitioning approach was applied to data from the Dose Ranging Efficacy And safety with Mepolizumab (DREAM) study to identify characteristics that maximized the differences across subgroups. Exacerbation rate ratios were calculated for each cluster comparing mepolizumab versus placebo.

MEASUREMENTS AND MAIN RESULTS

Three predictors were identified in four primary clusters: blood eosinophils, airway reversibility, and body mass index. The reduction in exacerbations was significantly greater in patients who received mepolizumab (clusters 2, 3, and 4) with raised eosinophils (responder population). Cluster 2 with low airway reversibility (mean, 11%) had a 53% reduction in exacerbations. These patients more frequently reported sinusitis and nasal polyposis. Those with higher airway reversibility (mean, 28%) were further split by body mass index. The nonobese versus obese (clusters 3 and 4) had a 35 and 67% reduction in exacerbations, respectively. Cluster 4 also had patients with more comorbidities, including hypertension, weight gain, and anxiety.

CONCLUSIONS

Using supervised cluster analysis helped identify specific patient characteristics related to disease and therapeutic response. Patients with eosinophilic inflammation received significant therapeutic benefit with mepolizumab, and responses differed within clusters. Clinical trial registered with www.clinicaltrials.gov (NCT01000506).

The diversity of young adult wheeze: a cluster analysis in a longitudinal birth cohort

BACKGROUND

Cluster analyses have enhanced understanding of the heterogeneity of both paediatric and adult wheezing. However, while adolescence represents an important transitional phase, the nature of young adult wheeze has yet to be clearly characterised.

OBJECTIVES

To use cluster analysis to define, for the first time, clinically relevant young adult wheeze clusters in a longitudinal birth cohort.

METHODS

K-means cluster analysis was undertaken among 309 currently wheezing subjects at 18 years in the Isle of Wight birth cohort (N = 1456). Thirteen disease-characterising clustering variables at 18 years were used. Resulting clusters were then further characterised by severity indices plus potential risk factors for wheeze development throughout the 1st 18 years of life.

RESULTS

Six wheeze clusters were identified. Cluster 1 (12.3%) male-early-childhood-onset-atopic-wheeze-with-normal-lung-function had male predominance, normal spirometry, low bronchodilator reversibility (BDR), intermediate bronchial hyper-responsiveness (BHR), high atopy prevalence and more admissions. Cluster 2 (24.2%) early-childhood-onset-wheeze-with-intermediate-lung-function had no specific sex association, intermediate spirometry, BDR, BHR, more significant BTS step therapy and admissions. Cluster 3 (9.7%) female-early-childhood-onset-atopic-wheeze-with-impaired-lung-function showed female predominance, high allergic disease comorbidity, more severe BDR and BHR, greatest airflow obstruction, high smoking prevalence, higher symptom severity and admissions. Cluster 4 (19.4%) female-undiagnosed-wheezers had adolescent-onset non-atopic wheeze, low BDR and BHR, impaired but non-obstructed spirometry, high symptom frequency and highest smoking prevalence. Cluster 5 (24.6%) female-late-childhood-onset-wheeze-with-normal-lung-function showed no specific atopy association, normal spirometry, low BDR, BHR and symptom severity. Cluster 6 (9.7%) male-late-childhood-onset-atopic-wheeze-with-impaired-lung-function had high atopy and rhinitis prevalence, increased BDR and BHR, moderately impaired spirometry, high symptom severity and higher BTS step therapy.

CONCLUSIONS AND CLINICAL RELEVANCE

Young adult wheeze is diverse and can be classified into distinct clusters. More severe clusters merit attention and are associated with childhood onset, atopy, impaired lung function and in some, smoking. Smoking-associated undiagnosed wheezers also merit recognition. Better understanding of young adult wheeze could facilitate better later adult respiratory health.

Real-time asthma outreach reduces excessive short-acting β2-agonist use: a randomized study

BACKGROUND

Excessive use of short-acting β2-agonists (SABA) indicates impaired asthma control.

OBJECTIVE

To determine whether real-time outreach to excessive SABA users reduces SABA canister dispensings.

METHODS

After real-time determination of a seventh SABA canister dispensing in the prior 12 months by using informational pharmacy technology, 12 to 56 year old patients with physician-coded asthma and inhaled corticosteroid dispensing were block randomized by prior asthma specialist care and medication step-care level into intervention (n = 1001) and control groups (n = 998). Intervention included real-time letter notification to patients and an electronic message to their physician with management suggestions, including facilitated allergy referral for patients without prior asthma specialist care. The control group received this organization's standard asthma care management without research contact. Frequency of the seventh SABA canister dispensing in the follow-up year was the primary outcome.

RESULTS

Compared with controls, intervention patients reached 7 SABA canister dispensings less frequently (50.7% vs 57.1%; risk ratio 0.89 [95% CI, 0.82-0.97]; P = .007) and later (hazard ratio 0.80 [95% CI, 0.71-0.91; P < .001). SABA canister dispensings (mean ± SD) were less in intervention (7.5 ± 4.9 canisters) than controls (8.6 ± 5.3 canisters) (rate ratio 0.87 [95% CI, 0.82-0.93]; P < .001). The intervention reduced the risk of ≥7 SABA canister dispensings in patients without specialist care compared with patients with specialist care in the prior 3 years (P < .001) (P = .04 for interaction by prior specialist care). Visits to allergists were more frequent for intervention patients (30.9%) than for control patients (16.8%) (risk ratio 1.83 [95% CI, 1.54-2.16]; P < .001). Asthma exacerbations were unaffected.

CONCLUSIONS

A novel administrative-based asthma outreach program improves markers of asthma impairment in patients without prior asthma specialist care and is adaptable to managed care organizations with electronic medical records.

Phenotypes determined by cluster analysis in severe or difficult-to-treat asthma

BACKGROUND

Asthma phenotyping can facilitate understanding of disease pathogenesis and potential targeted therapies.

OBJECTIVE

To further characterize the distinguishing features of phenotypic groups in difficult-to-treat asthma.

METHODS

Children ages 6-11 years (n = 518) and adolescents and adults ages ≥12 years (n = 3612) with severe or difficult-to-treat asthma from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study were evaluated in this post hoc cluster analysis. Analyzed variables included sex, race, atopy, age of asthma onset, smoking (adolescents and adults), passive smoke exposure (children), obesity, and aspirin sensitivity. Cluster analysis used the hierarchical clustering algorithm with the Ward minimum variance method. The results were compared among clusters by χ(2) analysis; variables with significant (P < .05) differences among clusters were considered as distinguishing feature candidates. Associations among clusters and asthma-related health outcomes were assessed in multivariable analyses by adjusting for socioeconomic status, environmental exposures, and intensity of therapy.

RESULTS

Five clusters were identified in each age stratum. Sex, atopic status, and nonwhite race were distinguishing variables in both strata; passive smoke exposure was distinguishing in children and aspirin sensitivity in adolescents and adults. Clusters were not related to outcomes in children, but 2 adult and adolescent clusters distinguished by nonwhite race and aspirin sensitivity manifested poorer quality of life (P < .0001), and the aspirin-sensitive cluster experienced more frequent asthma exacerbations (P < .0001).

CONCLUSION

Distinct phenotypes appear to exist in patients with severe or difficult-to-treat asthma, which is related to outcomes in adolescents and adults but not in children. The study of the therapeutic implications of these phenotypes is warranted.

Predictors of exacerbations of asthma and COPD during one year in primary care

AIMS

To investigate the incidence of asthma and chronic obstructive pulmonary disease (COPD) exacerbations in primary care during one year and to identify risk factors for such events.

METHODS

The study was carried out at seven general practice offices in Norway. Patients aged 40 years or more registered with a diagnosis of asthma and/or COPD the previous 5 years were included. After a baseline examination, the participants consulted their GP during exacerbations for the following 12 months. A questionnaire on exacerbations during the follow-up year was distributed to all. Univariable and multivariable logistic regression was performed to determine predictors of future exacerbations.

RESULTS

Three hundred and eighty patients attended the baseline examination and complete follow-up data were retrieved from 340 patients. COPD as defined by forced expiratory volume in the first second of expiration/forced vital capacity (FEV1/FVC) < 0.7, was found in 132 (38.8%) patients. One hundred and fifty-nine patients (46.8%) experienced one exacerbation or more and 101 (29.7%) two exacerbations or more. Patients who had an exacerbation treated with antibiotics or systemic corticosteroids or leading to hospitalization the year before baseline (N = 88) had the highest risk of getting an exacerbation during the subsequent year (odds ratio 9.2), whether the FEV1/FVC was below 0.7 or not. Increased risk of future exacerbations was also related to age ≥ 65 years and limitations in social activities, but not to the FEV1.

CONCLUSIONS

The study confirms that previous exacerbations strongly predict future exacerbations in patients with COPD or asthma. Identification and a closer follow-up of patients at risk of such events could promote earlier treatment when necessary and prevent a rapid deterioration of their condition.

Association of CHI3L1 in African-Americans with prior history of asthma exacerbations and stress

RATIONALE

Asthma exacerbations are influenced by multiple factors including environmental exposures, psychosocial interactions, and genetic variations.

AIM

To better understand the correlation between clinical, physiologic, genetic, and psychological dimensions in asthma phenotypes and exacerbations.

METHODS

Supervised cluster analysis of a previously conducted clinical trial of asthma was used to identify subpopulations with differing exacerbation rates in an African-American study population (n = 475). The clusters were characterized by their clinical characteristics and genetic variations. The genetic analysis (n = 322) compared subgroups across 40 different polymorphisms of 10 genes associated with asthma exacerbations.

RESULTS

Four clusters were identified with varying annualized rates of exacerbations. Cluster 1 (n = 272) was represented by subjects with a mean age of 25 years and 52% females. In contrast, cluster 4, most divergent from cluster 1, was represented by subjects with the highest rate of asthma exacerbations (1.18 events per year), was mostly female (>80%), with a mean body mass index of 34, and was distinguished by the report of stress and emotions as the cause for prior exacerbations. Lower lung function and increased rescue medication use was also reported in cluster 4. Additionally, genetic analysis revealed a significant difference in distribution of genotypes among the four clusters for rs4950928, a single nucleotide polymorphism (SNP) located in the promoter region of the CHI3L1, the chitinase 3-like 1 gene encoding YKL-40.

CONCLUSIONS

African-Americans who reported stress and emotions as a primary historical cause of exacerbations had the highest annualized rate of exacerbation. Further, a significant correlation with the genotypes in CHI3L1/YKL-40 was observed in the context of stress and asthma severity.

Factors predicting severe childhood obesity in kindergarteners

BACKGROUND

Severe obesity has increased >300% in US children since 1976, and is associated with multiple cardiovascular risk factors and high adult obesity rates.

OBJECTIVE

The objective of this study was to identify predictors of severe obesity in kindergarteners.

METHODS

Multivariable logistic regression and recursive partitioning analysis (RPA) were used to identify prenatal/pregnancy, infant, and early childhood predictors of severe kindergarten obesity (body mass index (BMI) 99th percentile) in the Early Childhood Longitudinal Study Birth Cohort, a nationally representative longitudinal study that followed children from birth through kindergarten.

RESULTS

For the 6800 children, the severe kindergarten obesity prevalence was 5.7%, with higher adjusted odds for crossing the 85th percentile of BMI at 2 years old (odds ratio (OR), 8.0; 95% confidence interval (CI), 4.1-15.7), preschool age (OR, 7.9; 95% CI, 4.9-12.8) and 9 months old (OR, 1.8; 95% CI, 1.2-2.6); maternal severe obesity (OR, 3.4; 95% CI, 1.9-5.8) and gestational diabetes (OR, 2.9; 95% CI, 1.5-5.5); drinking tea or coffee between meals/before bedtime at 2 years old (OR, 3.3; 95% CI, 1.3-8.5); Latino (OR, 2.3; 95% CI, 1.4-3.7) and multiracial (OR, 2.3; 95% CI, 1.1-4.8) race/ethnicity; and drinking sugary beverages at kindergarten age at least weekly (OR, 2.3; 95% CI, 1.4-3.7). Ever-attending center-based daycare (OR, 0.3; 95% CI, 0.1-0.9), eating fruit at least weekly at kindergarten age (OR, 0.3; 95% CI, 0.1-0.7), and maternal history of a prior newborn birth weight 4000 g (OR, 0.1; 95% CI, 0.02-0.6) were associated with reduced odds of severe obesity. RPA identified low severe obesity prevalence (1.9%) for non-85th BMI-percentile preschool crossers and high severe obesity (56-80%) for predictor clusters which included crossing the 85th BMI percentile at earlier ages, low parental education, specific maternal age cutoffs, preschooler bedtime rules, and outside walking/play frequency for 9-month-olds.

CONCLUSIONS

Certain parental, prenatal/pregnancy, infant, and early childhood factors, both alone and in combination, are potent predictors of severe obesity in kindergarteners.

Racial and ethnic differences in the management of childhood asthma in the United States

OBJECTIVES

We examined racial and ethnic differences in the management of childhood asthma in the United States and the extent that care conformed to clinical best practices.

METHODS

Two years of pooled data from the National Health Interview Survey were analyzed using logistic regression. The sample included all children between ages 2 and 17 years who had asthma currently and had been diagnosed with asthma by a doctor or health professional (n = 1757; 465 African-American, 212 Mexican-American, 190 Puerto Rican and other Hispanic, 806 white, non-Hispanic, and 84 children of other and multiple races and ethnicities).

RESULTS

African-American children with asthma were significantly less likely than white, non-Hispanic children to have taken preventive asthma medication, but more likely to have had an asthma management plan. Mexican-American and Puerto Rican and other Hispanic children did not differ significantly from white, non-Hispanic children in either receiving preventive asthma medication or having an asthma management plan. Caregivers of African-American and Puerto Rican and other Hispanic children were more likely to report that they or their child had taken a course or class on how to manage their child's asthma. We did not find racial or ethnic differences in the extent children used quick-relief asthma medication or received advice about reducing asthma triggers in their home, school, or work environments.

CONCLUSIONS

This work highlights a need for more research on racial and ethnic differences in asthma management. Implications for public health responses and racial and ethnic disparities in asthma morbidity are discussed.