SESSION TYPE: Pediatric Chest Disease
PRESENTED ON: Sunday, October 21, 2012 at 10:30 AM - 11:45 AM
PURPOSE: Acute asthma is a common cause of illness and hospitalization in children. Children of Hispanic ethnicity are disproportionately affected with asthma and may be at risk for more severe disease. Genetic factors, specifically polymorphisms of the β2-adrenergic receptor (ADRβ2), may play a role in a child’s severity of illness during an acute asthma exacerbation although the specific nature of this association is not well established.
METHODS: We performed genotyping of the ADRβ2 at amino acid positions 16 and 27 in a cohort of 205 children admitted to the hospital with asthma over a 9-year period. Clinical factors and genotypes of the ADRβ2 were compared to outcomes while stratifying by race/ethnicity. A severe exacerbation was defined as admission to the intensive care unit (ICU).
RESULTS: In this cohort, 64 children of Hispanic ethnicity were admitted to the hospital, 61% (n=39) of whom had at least one admission the the ICU for severe asthma. ICU admission was not associated with age, gender or insurance status. However, Hispanic children with severe persistent asthma were significantly more likely to have been admitted to the ICU compared to those with other asthma classifications (OR 9.4; 95% CI 1.1-78.4; p=0.04). Hispanic children with the Arg16Gly-Gln27Gln genotype were also 8 times more likely to be admitted to the ICU with a severe exacerbation than those with other genotype of the ADRβ2 (OR 8.4; 95% CI 1.7-41.0; p=0.009), even when accounting for asthma classification. Also in this cohort, 68 Caucasian and 59 African-American children were admitted to the hospital, 75% (n=51) and 66% (n=39) of whom were admitted to the ICU at last once. There were no associations between genotype and admission to the ICU in these groups.
CONCLUSIONS: In a cohort of children admitted with acute asthma, Hispanic children with the Arg16Gly-Gln27Gln genotype of the ADRβ2 were at greater risk for severe disease during an exacerbation.
CLINICAL IMPLICATIONS: Genetic factors may influence the development of a more severe asthma phenotype during acute exacerbations.
DISCLOSURE: The following authors have nothing to disclose: Christopher Carroll, Kathleen Sala, Aaron Zucker, Craig Schramm
No Product/Research Disclosure InformationConnecticut Children's Medical Center, Hartford, CT