New thinking in childhood asthma diagnosis approach

A vital aspect of clinical research is ensuring that trial results are applicable to the larger population impacted by the condition under study. This is accomplished by enrolling a broad range of participants across a variety of demographic groups (age, gender, race, and ethnicity). Understanding how different groups respond (or don’t) to treatments is a key part of the drug approval process. This is especially important when a disease is known to impact certain groups more frequently or intensely than others. Representation also matters for research that looks at how illness is diagnosed.

Asthma, for example, affects millions of adults and children. In the US however, black individuals are 40% more likely to have asthma than white individuals. More troubling is that black children are 8 times more likely to die from asthma than white children. There are a number of reasons for this increased asthma risk that black individuals face:

Environmental factors: Living in areas with higher amounts of air pollution – for example, urban areas with industrial manufacturing. Poor air quality outside the home, and inside the home as well, increases the risk of asthma. 

Socioeconomic barriers: Limited access to healthcare services along with insurance issues and transportation challenges can delay timely treatment.

Medical and family history: Conditions such as obesity increase risk of asthma. In addition, children may have been exposed to toxins such as everyday chemicals, when in the womb. Genetic predispositions are also likely contributors to the higher asthma rates seen in black children.

New studies looking at the diagnosis process of asthma in black children have uncovered some surprising findings that may impact how and when asthma is diagnosed in this higher risk group. Historically, asthma has been diagnosed based on data that takes into account demographics such as age, sex, gender and race. Race as a factor was included in the asthma diagnostic calculations given an association between race and variability in lung function.

Though intentions were good, the calculation has recently been revealed to be problematic. It has been demonstrated that there is a good chance that diagnosis could actually be delayed as a result of race-specific calculations. Earlier this year it was found that usage of a race-neutral equation led to nearly 40% increase in asthma detection in black children. Researchers are hopeful that this approach will be adopted given the impact of more timely diagnosis and treatment planning in an already vulnerable population. In fact, in 2023 the American Thoracic Society recommended that all pulmonary function testing labs switch to race-neutral interpretation and results.

An accurate diagnosis of asthma is important – this is what will help establish the treatment plan. If you are concerned about your child and wondering about asthma, talk to a pediatric healthcare provider about asthma testing options.