Pathways through which asthma risk factors contribute to asthma severity in inner-city children

Andrew H. Liu*, Denise C. Babineau, Rebecca Z. Krouse, Edward M. Zoratti, Jacqueline A. Pongracic, George T. O'Connor, Robert A. Wood, Gurjit K. Khurana Hershey, Carolyn M. Kercsmar, Rebecca S. Gruchalla, Meyer Kattan, Stephen J. Teach, Melanie Makhija, Dinesh Pillai, Carin I. Lamm, James E. Gern, Steven M. Sigelman, Peter J. Gergen, Alkis Togias, Cynthia M. VisnessWilliam W. Busse

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

61 Scopus citations


Background Pathway analyses can be used to determine how host and environmental factors contribute to asthma severity. Objective To investigate pathways explaining asthma severity in inner-city children. Methods On the basis of medical evidence in the published literature, we developed a conceptual model to describe how 8 risk-factor domains (allergen sensitization, allergic inflammation, pulmonary physiology, stress, obesity, vitamin D, environmental tobacco smoke [ETS] exposure, and rhinitis severity) are linked to asthma severity. To estimate the relative magnitude and significance of hypothesized relationships among these domains and asthma severity, we applied a causal network analysis to test our model in an Inner-City Asthma Consortium study. Participants comprised 6- to 17-year-old children (n = 561) with asthma and rhinitis from 9 US inner cities who were evaluated every 2 months for 1 year. Asthma severity was measured by a longitudinal composite assessment of day and night symptoms, exacerbations, and controller usage. Results Our conceptual model explained 53.4% of the variance in asthma severity. An allergy pathway (linking allergen sensitization, allergic inflammation, pulmonary physiology, and rhinitis severity domains to asthma severity) and the ETS exposure pathway (linking ETS exposure and pulmonary physiology domains to asthma severity) exerted significant effects on asthma severity. Among the domains, pulmonary physiology and rhinitis severity had the largest significant standardized total effects on asthma severity (−0.51 and 0.48, respectively), followed by ETS exposure (0.30) and allergic inflammation (0.22). Although vitamin D had modest but significant indirect effects on asthma severity, its total effect was insignificant (0.01). Conclusions The standardized effect sizes generated by a causal network analysis quantify the relative contributions of different domains and can be used to prioritize interventions to address asthma severity.

Original languageEnglish (US)
Pages (from-to)1042-1050
Number of pages9
JournalJournal of Allergy and Clinical Immunology
Issue number4
StatePublished - Oct 1 2016


  • Asthma
  • allergy
  • children
  • environmental tobacco smoke exposure
  • inflammation
  • inner-city
  • lung function
  • pulmonary physiology
  • rhinitis
  • sensitization

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology


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