Collaborative ECHO research led by Rachel L. Miller, MD of Icahn School of Medicine at Mount Sinai and Christine C. Johnson, PhD, MPH of Henry Ford Health System investigates the factors that influence the rates of childhood asthma with recurrent exacerbations (ARE)—a subtype of asthma where children experience frequent, severe episodes of asthma. The researchers leveraged data from over 17,000 children born between 1990 and 2017 and found that children ages 2-4 years old, non-Hispanic Black and Hispanic Black children, and children who lived in the Northeast and Midwest had the highest incidence rates of ARE. Additionally, children with a parental history of asthma had ARE rates almost 3 times greater compared to those with no parental history. This research, titled “Incidence Rates of Childhood Asthma with Recurrent Exacerbations in the U.S. Environmental influences on Child Health Outcomes (ECHO) Program,” is published in The Journal of Allergy and Child Immunology.
While the prevalence of asthma has been reported widely in the United States and elsewhere, studies on childhood asthma incidence rates within specific populations and across various types of asthma and age ranges have been limited. “Describing the incidence rates of ARE across a large, diverse population of children is a critical first step for identifying potential risk factors and causes,” explained Dr. Johnson.
To conduct this research, the research team leveraged data from children enrolled in 60 ECHO cohorts across the U.S. and Puerto Rico. Child participants or their caregivers reported whether and when the child had an asthma diagnosis and any corticosteroids prescribed over time from their health care providers. Recurrent exacerbations of asthma were based on reports of systemic (not inhaled) corticosteroid use. The researchers calculated incidence rates of ARE for the study population overall, along with rates for subsets of the population defined by the years the ARE were diagnosed, the decade children were born, their age and sex, their race and ethnicity, their residence at birth, and their parents’ history of asthma.
“While children with ARE are all different, these findings suggest that we should examine in the future key elements of the early environment, including viral respiratory tract infections, indoor allergens, environmental tobacco smoke, air pollution, stress, and socioeconomic status, which could contribute to ARE,” said Dr. Miller. “Understanding these causes will help researchers determine how to best prevent ARE and associated asthma outcomes.”