title: Race is associated with differences in airway inflammation in patients with asthma.
abstract: BACKGROUND
  African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear.
  
  
  OBJECTIVE
  We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS-, respectively).
  
  
  METHODS
  We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute-sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype.
  
  
  RESULTS
  Among 1018 participants, African American subjects (n = 264) had a lower FEV1percent predicted (80% vs 85%, P < .01), greater total IgE levels (197 vs 120 IU/mL, P < .01), and a greater proportion with uncontrolled asthma (43% vs 28%, P < .01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS- group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P = .28; ICS- group: 39% vs 35%, P = .65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P = .046) but not in the ICS- group (P = .984).
  
  
  CONCLUSIONS
  African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill. Electronic address: snyenhui@uic.edu.
authors.forename: Sharmilee M
authors.initials: SM
authors.lastname: Nyenhuis
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Ill; University of Illinois Hospital & Health Sciences System, Chicago, Ill.
authors.forename: Jerry A
authors.initials: JA
authors.lastname: Krishnan
authors.affiliation: Division of Allergy, Pulmonary and Critical Care, Department of Medicine, the University of Wisconsin School of Medicine and Public Health, University of Wisconsin, Madison, Wis.
authors.forename: Alalia
authors.initials: A
authors.lastname: Berry
authors.affiliation: Division of Pulmonary Critical Care & Sleep Medicine, Department of Internal Medicine, University of Texas Medical Branch, Galveston, Tex.
authors.forename: William J
authors.initials: WJ
authors.lastname: Calhoun
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa.
authors.forename: Vernon M
authors.initials: VM
authors.lastname: Chinchilli
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa.
authors.forename: Linda
authors.initials: L
authors.lastname: Engle
authors.affiliation: Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Nicole
authors.initials: N
authors.lastname: Grossman
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Fernando
authors.initials: F
authors.lastname: Holguin
authors.affiliation: Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass.
authors.forename: Elliot
authors.initials: E
authors.lastname: Israel
authors.affiliation: University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: Rick A
authors.initials: RA
authors.lastname: Kittles
authors.affiliation: University of Arizona College of Medicine, Tucson, Ariz.
authors.forename: Monica
authors.initials: M
authors.lastname: Kraft
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine, University of California, San Francisco, Calif.
authors.forename: Stephen C
authors.initials: SC
authors.lastname: Lazarus
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa.
authors.forename: Erik B
authors.initials: EB
authors.lastname: Lehman
authors.affiliation: Department of Public Health Sciences, Pennsylvania State University, Hershey, Pa.
authors.forename: David T
authors.initials: DT
authors.lastname: Mauger
authors.affiliation: Stroger Hospital of Cook County, Chicago, Ill.
authors.forename: James N
authors.initials: JN
authors.lastname: Moy
authors.affiliation: Division of Pulmonary, Critical Care, Allergy and Immunologic Diseases, Department of Medicine, Wake Forest School of Medicine, Winston-Salem, NC.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Peters
authors.affiliation: Division of Allergy and Immunology, Department of Pediatrics, Boston Children's Hospital, Boston, Mass.
authors.forename: Wanda
authors.initials: W
authors.lastname: Phipatanakul
authors.affiliation: Division of Pulmonary and Critical Care, Department of Medicine Northwestern University, Feinberg School of Medicine, Chicago, Ill.
authors.forename: Lewis J
authors.initials: LJ
authors.lastname: Smith
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St Louis, Mo.
authors.forename: Kaharu
authors.initials: K
authors.lastname: Sumino
authors.affiliation: Division of Pulmonary Medicine, Department of Pediatrics, Children's Hospital of Colorado, Aurora, Colo.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.affiliation: Pulmonary and Critical Care Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Mass; Division of Pulmonary, Critical Care and Sleep Medicine, Department of Medicine, National Jewish Health, Denver, Colo.
authors.forename: Michael E
authors.initials: ME
authors.lastname: Wechsler
authors.affiliation: Division of Pulmonary, Allergy and Critical Care Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pa.
authors.forename: Sally
authors.initials: S
authors.lastname: Wenzel
authors.affiliation: Division of Pulmonary/Critical Care, Department of Medicine, University of Chicago, Chicago, Ill.
authors.forename: Steven R
authors.initials: SR
authors.lastname: White
authors.affiliation: Department of Medicine, University of Illinois at Chicago, Chicago, Ill.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Ackerman
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D044383:Black People; D004802:Eosinophilia / Q000188:drug therapy / Q000453:epidemiology* / Q000276:immunology / Q000503:physiopathology; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D009504:Neutrophils / Q000276:immunology; D010641:Phenotype; D013183:Sputum / Q000166:cytology; D044465:White People; D055815:Young Adult; D001741:Black or African American
chemical_list: D000305:Adrenal Cortex Hormones; D007073:Immunoglobulin E
keywords: African American; Asthma; airway inflammation; body mass index; clinical trial; corticosteroid; eosinophil; induced sputum; race