Impact of race on asthma treatment failures in the asthma clinical research network.
Impact of race on asthma treatment failures in the asthma clinical research network.
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哮喘临床研究网络中种族对哮喘治疗失败的影响。
DOI：
10.1164/rccm.201103-0514oc
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发表时间：
2011
影响因子：
24.7
通讯作者：
NHLBIAsthmaClinicalResearchNetwork
中科院分区：
文献类型：
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作者：
Wechsler,MichaelE;Castro,Mario;Lehman,Erik;Chinchilli,VernonM;Sutherland,ERand;Denlinger,Loren;Lazarus,StephenC;Peters,StephenP;Israel,Elliot;NHLBIAsthmaClinicalResearchNetwork
基本原理：最近的研究表明，不同种族背景的哮喘患者对不同疗法的反应可能不同。目的：使用既往哮喘临床研究网络（ACRN）试验中特征良好的参与者的数据，以确定种族差异是否影响哮喘治疗失败。方法：我们分析了基线表型和治疗失败率（哮喘恶化导致全身使用皮质类固醇、住院、急诊、呼气峰流量长期下降、沙丁胺醇使用增加，或安全性问题）。测量和主要结果：共有1，200名独特的受试者（白人= 795 [66%];非洲裔美国人= 233 [19%];其他= 172 [14%];平均年龄= 32）被纳入分析。基线时，非裔美国人的哮喘症状（P< 0.001）和平均每日急救吸入器使用量（P= 0.007）少于白人。基线FEV 1（%预测值）、哮喘生活质量、支气管高反应性或呼出气一氧化氮浓度无差异。共观察到147例治疗失败;与白人（12.7%; n = 101）相比，非洲裔美国人（19.7%; n = 46）治疗失败的比例显著更高（比值比= 1.7; 95%置信区间，1.2-2.5;P= 0.007）。当按治疗分层时，接受长效β受体激动剂的非裔美国人经历治疗失败的可能性是白人的两倍（比值比= 2.1; 95%置信区间，1.3-3.6;P= 0.004），即使与其他控制疗法联合使用。尽管有较少的哮喘症状和较少的救援β-激动剂的使用，非洲裔美国人有更多的哮喘治疗失败相比，白人，尤其是服用长效β受体激动剂时。
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 10 ACRN trials (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 FEV1(% 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 African Americans (19.7%; n = 46) experienced a 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.