title: Impact of race on asthma treatment failures in the asthma clinical research network.
abstract: BACKGROUND
  Recent studies suggest that people with asthma of different racial backgrounds may respond differently to various therapies.
  
  
  OBJECTIVE
  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.
  
  
  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 FEV(1) (% 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.
authors: Brigham & Women's Hospital, Boston, MA 02115, USA. mwechsler@partners.org
authors: Michael E
authors: ME
authors: Wechsler
authors: Mario
authors: M
authors: Castro
authors: Erik
authors: E
authors: Lehman
authors: Vernon M
authors: VM
authors: Chinchilli
authors: E Rand
authors: ER
authors: Sutherland
authors: Loren
authors: L
authors: Denlinger
authors: Stephen C
authors: SC
authors: Lazarus
authors: Stephen P
authors: SP
authors: Peters
authors: Elliot
authors: E
authors: Israel
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use*; D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data*; D000420:Albuterol / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy* / Q000208:ethnology*; D035843:Biomedical Research / Q000379:methods; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009330:Nebulizers and Vaporizers; D016017:Odds Ratio; D010366:Peak Expiratory Flow Rate / Q000187:drug effects; D017211:Treatment Failure; D044465:White People / Q000706:statistics & numerical data*
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents; D000420:Albuterol