Lower bronchodilator responsiveness in Puerto Rican than in Mexican subjects with asthma.
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% CI, 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 beta2-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.
Burchard
Esteban González
EG
University of California, San Francisco, 94143-0833, USA. eburch@itsa.ucsf.edu
Avila
Pedro C
PC
Nazario
Sylvette
S
Casal
Jesus
J
Torres
Alfonso
A
Rodriguez-Santana
Jose R
JR
Toscano
Monica
M
Sylvia
Jody Senter
JS
Alioto
MariaElena
M
Salazar
Michael
M
Gomez
Ivan
I
Fagan
Joanne K
JK
Salas
Jorge
J
Lilly
Craig
C
Matallana
Henry
H
Ziv
Elad
E
Castro
Richard
R
Selman
Moises
M
Chapela
Rocio
R
Sheppard
Dean
D
Weiss
Scott T
ST
Ford
Jean G
JG
Boushey
Homer A
HA
Rodriguez-Cintron
William
W
Drazen
Jeffrey M
JM
Silverman
Edwin K
EK
D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000208:ethnology*; D001985:Bronchial Provocation Tests; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D017058:Mexican Americans; D011336:Probability; D011379:Prognosis; D012129:Respiratory Function Tests; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D001993:Bronchodilator Agents