Impact of race on asthma treatment failures in the Asthma Clinical Research Network

Michael E. Wechsler, Mario Castro, Erik Lehman, Vernon M. Chinchilli, E. Rand Sutherland, Loren Denlinger, Stephen C. Lazarus, Stephen P. Peters, Elliot Israel, Richard J. Martin, Stanley J. Szefler, Reuben Cherniack, Robert F. Lemanske, Christine A. Sorkness, Nizar Jarjour, Tim Craig, Susan J. Kunselman, Homer A. Boushey, John V. Fahy, Monica KraftSteven Wasserman, Joe Ramsdell, William J. Calhoun, Bill Ameredes, Michael Walter, Eugene Bleecker, Emily DiMango, Gene R. Pesola, Robert Smith

Research output: Contribution to journalArticlepeer-review

60 Scopus citations

Abstract

Rationale: Recent studies suggest that people with asthma of different racial backgrounds may respond differently to various therapies. Objectives: To use data from well-characterized participants in prior Asthma Clinical Research Network (ACRN) trials to determine whether racial differences affected asthma treatment failures. Methods: We analyzed baseline phenotypes and treatment failure rates (worsening asthma resulting in systemic corticosteroid use, hospitalization, emergency department visit, prolonged decrease in peak expiratory flow, increase in albuterol use, or safety concerns) in subjects participating in 10ACRNtrials (1993-2003). Self-declared race was reported in each trial and treatment failure rates were stratified by race. Measurements and Main Results: A total of 1,200 unique subjects (whites = 795 [66%]; African Americans = 233 [19%]; others = 172 [14%]; mean age = 32) were included in the analyses. At baseline, African Americans had fewer asthma symptoms (P < 0.001) and less average daily rescue inhaler use (P = 0.007) than whites. There were no differences in baseline FEV 1 (% predicted); asthma quality of life; bronchial hyperreactivity; or exhaled nitric oxide concentrations. A total of 147 treatment failures were observed; a significantly higher proportion of AfricanAmericans(19.7%;n=46) experienceda treatment failure compared with whites (12.7%; n = 101) (odds ratio = 1.7; 95% confidence interval, 1.2-2.5; P = 0.007). When stratified by treatment, African Americans receiving long-acting β-agonists were twice as likely as whites to experience a treatment failure (odds ratio = 2.1; 95% confidence interval, 1.3-3.6; P = 0.004), even when used with other controller therapies. Conclusions: Despite having fewer asthma symptoms and less rescue β-agonist use, African-Americans with asthma have more treatment failures compared with whites, especially when taking long-acting β-agonists.

Original languageEnglish (US)
Pages (from-to)1247-1253
Number of pages7
JournalAmerican journal of respiratory and critical care medicine
Volume184
Issue number11
DOIs
StatePublished - Dec 1 2011

Keywords

  • African Americans
  • Asthma
  • Long-acting β-agonist
  • Race
  • Treatment failure

ASJC Scopus subject areas

  • Pulmonary and Respiratory Medicine
  • Critical Care and Intensive Care Medicine

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