Use of long-acting bronchodilators had no impact for some African American children – Study

Health News

Study assesses asthma treatment options in African American children and adults

New York, 26th
September 2019. A new study of African Americans with poorly controlled
asthma,
found differences in patients’ responses to commonly used
treatments. Contrary to what researchers had expected, almost half of young
children in the study responded differently than older children and adults, and
than white children in prior studies.

“We
shouldn’t assume that current treatment strategies for asthma are
ideal for all African Americans since for many years that population was not
adequately represented in research,” said Elliot Israel, M.D., senior study
author and director of clinical research in the Pulmonary and Critical Care
Medicine Division at Brigham and Women’s Hospital.

“We found
that almost half of the African American children studied responded better to
increasing the dose of inhaled corticosteroids than adding a long-acting
bronchodilator. Thus, adding a long-acting bronchodilator may not be the right
answer for nearly half of African American children.”

The National
Heart, Lung, and Blood Institute (NHLBI), part of the National Institutes of
Health (USA), funded this research to assess the best approach to asthma
management
in African Americans, who suffer much higher rates of serious
asthma attacks,
hospitalizations, and asthma-related deaths than
whites. The findings appear today in the New England Journal of Medicine.

The
researchers examined how to escalate or “step-up” asthma treatments for African
Americans whose asthma had not been treated adequately with low doses of inhaled
corticosteroids,
the standard starting treatment. The treatment choices
in the trial included increasing the dose of inhaled steroid, adding a
long-lasting bronchodilator (used to help open airways), or both.

Based on
prior studies, investigators expected that increasing the inhaled
corticosteroid dose would lead to improvement in most African American children
needing treatment for asthma.

The
researchers found that in children under 12 years of age, either approach was
effective: nearly half (46%) responded better to increasing the inhaled
corticosteroid dose alone and just as many (46%) responded better to increasing
the inhaled corticosteroid dose and adding a long-lasting bronchodilator.

“This study
suggests that we cannot look at results from one population and extrapolate the
findings to African Americans or any other group,” said Michael Wechsler, M.D.,
principal investigator for the NHLBI-funded Best African American Response to
Asthma Drugs (BARD) study and professor of medicine at National Jewish Health
in Denver. “If children do not respond to one treatment, parents and providers
could consider another option because there is almost a 50% chance of having a
better response.”

The
multicenter study included 574 participants — about half of whom were ages 5–11
and half 12 years and older. All participants in this study had at least one
self-identified African American grandparent, with an average of approximately
80% African ancestry, based on genetic testing.

Of the
adolescents over 11 years old and adults, most (49%) responded better to adding
a long-lasting bronchodilator than to increasing the inhaled corticosteroid
dose, though 20–25% in this group showed no difference in their responses to
these approaches.

Investigators
also examined whether patient characteristics, including genetic ancestry,
could be used to predict the response to the “step-up” treatments in the study
participants. But they were unable to use genes indicative of African ancestry,
or any of the other patient characteristics they measured in this group of
patients, to predict treatment response.

“Although we
cannot attribute the study’s findings to genetic markers of African ancestry,
there could be as-yet unknown genetic variants specific to people of African
descent that affect how severe a patient’s asthma is,” said Wechsler.

Before the
trial began, the researchers did not expect the participants to have a better
response to treatment regimens that included long-lasting bronchodilators,
despite the inclusion of these agents in treatment recommendations. They said
they were surprised that many (46% of the young children and 49% of the older
children and adults) improved with long-lasting bronchodilators.

“These
results provide new data about the management of asthma patients who
self-identify as African American regardless of genetic ancestry,” said James
Kiley, Ph.D., director of the Division of Lung Diseases at NHLBI. “Every person
and their provider should explore all of their management choices to achieve
maximum asthma control, based on their response to specific medications.”

About the National Heart, Lung, and Blood Institute (NHLBI): NHLBI is the global leader in conducting and supporting research in heart, lung, and blood diseases and sleep disorders that advances scientific knowledge, improves public health, and saves lives.

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