Racial/Ethnic‐Specific Differences in the Effects of Inhaled Corticosteroid Use on Bronchodilator Response in Patients With Asthma

American Thoracic Society guidelines recommend inhaled corticosteroid (ICS) therapy, plus a short‐acting bronchodilator, in patients with persistent asthma. However, few prior studies have examined the efficacy of this combination in children of all racial/ethnic groups. We evaluated the association...

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Bibliographic Details
Published in:	Clinical pharmacology and therapeutics Vol. 106; no. 5; pp. 1133 - 1140
Main Authors:	Samedy‐Bates, Lesly‐Anne, Oh, Sam S., Nuckton, Thomas J., Elhawary, Jennifer R., White, Marquitta, Elliot, Tyronda, Zeiger, Andy M., Eng, Celeste, Salazar, Sandra, LeNoir, Michael A., Meade, Kelley, Farber, Harold J., Serebrisky, Denise, Brigino‐Buenaventura, Emerita, Rodriguez‐Cintron, William, Bibbins‐Domingo, Kirsten, Kumar, Rajesh, Thyne, Shannon, Borrell, Luisa N., Rodriguez‐Santana, José R., Pino‐Yanes, Maria, Burchard, Esteban G.
Format:	Journal Article
Language:	English
Published:	United States 01-11-2019
Subjects:	Administration, Inhalation Adolescent Adrenal Cortex Hormones - administration & dosage Adrenal Cortex Hormones - therapeutic use Asthma - drug therapy Asthma - ethnology Black or African American - statistics & numerical data Bronchodilator Agents - pharmacology Bronchodilator Agents - therapeutic use Child Female Forced Expiratory Volume Hispanic or Latino - statistics & numerical data Humans Male Mexican Americans - statistics & numerical data Puerto Rico - ethnology Racial Groups - statistics & numerical data United States - epidemiology United States Puerto Rico
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Summary:	American Thoracic Society guidelines recommend inhaled corticosteroid (ICS) therapy, plus a short‐acting bronchodilator, in patients with persistent asthma. However, few prior studies have examined the efficacy of this combination in children of all racial/ethnic groups. We evaluated the association between ICS use and bronchodilator response (BDR) in three pediatric populations with persistent asthma (656 African American, 916 Puerto Rican, and 398 Mexican American children). The association was assessed using multivariable quantile regression. After adjusting for baseline forced expiratory volume in one second and use of controller medications, ICS use was significantly associated with increased BDR only among Mexican Americans (1.56%, P = 0.028) but not African Americans (0.49%, P = 0.426) or Puerto Ricans (0.16%, P = 0.813). Our results demonstrate that ICS augmentation is disproportionate across racial/ethnic groups, where improved BDR is observed in Mexican Americans only. This study highlights the complexities of treating asthma in children, and reinforces the importance of investigating the influence of race/ethnicity on pharmacological response.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 AUTHOR CONTRIBUTIONS All authors wrote the manuscript; L.S., S.S.O., T.J.N., and E.G.B. designed the research; S.S., C.E., K.M., E.B.B., M.A.L., H.J.F., D.S., W.R.C., K.B.D., L.N.B., J.R.R., and E.G.B. performed the research; L.S., S.S.O., T.J.N., J.L.E., M.W., T.E., A.M.Z., K.M., E.B.D., R.K., S.T., M.P.Y., L.N.B., and E.G.B. analyzed the data.
ISSN:	0009-9236 1532-6535 1532-6535
DOI:	10.1002/cpt.1555