Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma
Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma
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DOI：
10.1164/rccm.200309-1293oc
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发表时间：
2004-02-01
影响因子：
24.7
通讯作者：
Silverman, EK
中科院分区：
文献类型：
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作者：
Burchard, EG;Avila, PC;Silverman, EK
在美国，波多黎各人和墨西哥人分别具有最高和最低的哮喘患病率、发病率和死亡率。为了确定治疗反应、临床反应和/或遗传因素方面的种族特异性差异是否导致哮喘结果的差异，我们比较了从旧金山、纽约市、波多黎各和墨西哥城招募的684名患有哮喘的墨西哥人和波多黎各人的哮喘相关临床特征。患有哮喘的波多黎各人比患有哮喘的墨西哥人肺功能降低、发病率更高且哮喘病程更长。以第一秒用力呼气量（FEV1）较基线的变化百分比来衡量的支气管扩张剂反应性，在患有哮喘的波多黎各人中明显低于患有哮喘的墨西哥人。患有哮喘的波多黎各人的FEV1支气管扩张剂可逆性平均比墨西哥人低7.3%（95%置信区间[CI]，4.6 - 9.9；p < 0.001），前一年因哮喘前往急诊科就诊的风险更高（比值比，2.63；95%CI，1.6 - 4.3；p < 0.001），且之前因哮喘住院的风险也更高（比值比，1.94；95%CI，1.2 - 3.2；p = 0.009）。亚组分析证实，基于肺功能测量、对β₂ -肾上腺素能激动剂的反应性以及医疗保健使用情况，患有哮喘的波多黎各人比墨西哥人病情更严重。我们得出结论，患有哮喘的波多黎各人对沙丁胺醇的反应不如患有哮喘的墨西哥人。这些发现强调了需要对哮喘发病率和治疗反应方面的种族/民族差异进行更多研究。
In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV1, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% Cl, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to beta(2)-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.