Unknown

Dataset Information

0

Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma.


ABSTRACT: BACKGROUND:Morbidity from asthma is disproportionately higher among black patients than among white patients, and black patients constitute the minority of participants in trials informing treatment. Data indicate that patients with inadequately controlled asthma benefit more from addition of a long-acting beta-agonist (LABA) than from increased glucocorticoids; however, these data may not be informative for treatment in black patients. METHODS:We conducted two prospective, randomized, double-blind trials: one involving children and the other involving adolescents and adults. In both trials, the patients had at least one grandparent who identified as black and had asthma that was inadequately controlled with low-dose inhaled glucocorticoids. We compared combinations of therapy, which included the addition of a LABA (salmeterol) to an inhaled glucocorticoid (fluticasone propionate), a step-up to double to quintuple the dose of fluticasone, or both. The treatments were compared with the use of a composite measure that evaluated asthma exacerbations, asthma-control days, and lung function; data were stratified according to genotypic African ancestry. RESULTS:When quintupling the dose of fluticasone (to 250 ?g twice a day) was compared with adding salmeterol (50 ?g twice a day) and doubling the fluticasone (to 100 ?g twice a day), a superior response occurred in 46% of the children with quintupling the fluticasone and in 46% of the children with doubling the fluticasone and adding salmeterol (P?=?0.99). In contrast, more adolescents and adults had a superior response to added salmeterol than to an increase in fluticasone (salmeterol-low-dose fluticasone vs. medium-dose fluticasone, 49% vs. 28% [P?=?0.003]; salmeterol-medium-dose fluticasone vs. high-dose fluticasone, 49% vs. 31% [P?=?0.02]). Neither the degree of African ancestry nor baseline biomarkers predicted a superior response to specific treatments. The increased dose of inhaled glucocorticoids was associated with a decrease in the ratio of urinary cortisol to creatinine in children younger than 8 years of age. CONCLUSIONS:In contrast to black adolescents and adults, almost half the black children with poorly controlled asthma had a superior response to an increase in the dose of an inhaled glucocorticoid and almost half had a superior response to the addition of a LABA. (Funded by the National Heart, Lung, and Blood Institute; BARD ClinicalTrials.gov number, NCT01967173.).

SUBMITTER: Wechsler ME 

PROVIDER: S-EPMC7026584 | biostudies-literature | 2019 Sep

REPOSITORIES: biostudies-literature

altmetric image

Publications

Step-Up Therapy in Black Children and Adults with Poorly Controlled Asthma.

Wechsler Michael E ME   Szefler Stanley J SJ   Ortega Victor E VE   Pongracic Jacqueline A JA   Chinchilli Vernon V   Lima John J JJ   Krishnan Jerry A JA   Kunselman Susan J SJ   Mauger David D   Bleecker Eugene R ER   Bacharier Leonard B LB   Beigelman Avraham A   Benson Mindy M   Blake Kathryn V KV   Cabana Michael D MD   Cardet Juan-Carlos JC   Castro Mario M   Chmiel James F JF   Covar Ronina R   Denlinger Loren L   DiMango Emily E   Fitzpatrick Anne M AM   Gentile Deborah D   Grossman Nicole N   Holguin Fernando F   Jackson Daniel J DJ   Kumar Harsha H   Kraft Monica M   LaForce Craig F CF   Lang Jason J   Lazarus Stephen C SC   Lemanske Robert F RF   Long Dayna D   Lugogo Njira N   Martinez Fernando F   Meyers Deborah A DA   Moore Wendy C WC   Moy James J   Naureckas Edward E   Olin J Tod JT   Peters Stephen P SP   Phipatanakul Wanda W   Que Loretta L   Raissy Hengameh H   Robison Rachel G RG   Ross Kristie K   Sheehan William W   Smith Lewis J LJ   Solway Julian J   Sorkness Christine A CA   Sullivan-Vedder Lisa L   Wenzel Sally S   White Steven S   Israel Elliot E  

The New England journal of medicine 20190901 13


<h4>Background</h4>Morbidity from asthma is disproportionately higher among black patients than among white patients, and black patients constitute the minority of participants in trials informing treatment. Data indicate that patients with inadequately controlled asthma benefit more from addition of a long-acting beta-agonist (LABA) than from increased glucocorticoids; however, these data may not be informative for treatment in black patients.<h4>Methods</h4>We conducted two prospective, random  ...[more]

Similar Datasets

| S-EPMC3011177 | biostudies-literature
| S-EPMC2989902 | biostudies-literature
| S-EPMC3578966 | biostudies-literature
| S-EPMC4153372 | biostudies-literature
| S-EPMC5862725 | biostudies-literature
| S-EPMC3365022 | biostudies-other
| S-EPMC5722723 | biostudies-literature