Background Inhaled corticosteroids (ICS) are the preferred treatment for achieving asthma control. However, little is known regarding the factors contributing to treatment response and whether treatment response differs by population group. Objective To assess behavioral, socio-demographic, and genetic factors related to ICS response among African American and European American individuals with asthma. Methods Study participants were part of the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). The analytic sample included individuals with asthma aged 12–56 years, >12% bronchodilator reversibility, and a percent of predicted forced expiratory volume at one second (FEV1) between 40–90%. Participants received 6 weeks of inhaled beclomethasone dipropionate. The primary measure of ICS response was a change in Asthma Control Test (ACT) score; the secondary measure was the change in pre-bronchodilator FEV1. Adherence was measured with electronic monitors. Genetic ancestry was estimated for African American participants using genome-wide genotype data. Results There were 339 study participants; 242 self-identified as African American and 97 as European American. Baseline ACT score, percent of predicted FEV1, degree of bronchodilator response, and ICS adherence were significantly associated with ICS response. A baseline ACT score ≤19 was useful in identifying those who would respond as evidenced by the significant dose-response relationship with ICS adherence. Neither self-reported race-ethnicity among all participants nor proportion of African ancestry among African American participants was associated with ICS responsiveness. Conclusions Our findings suggest that baseline lung function measures and self-reported asthma control predict ICS response, whereas self-reported race-ethnicity and genetic ancestry do not.

Background Current U.S. guidelines recommend the Asthma Control Test (ACT) for assessing disease control and selecting treatment. Objective The goal of this study was to prospectively assess the ACT and its component questions for their utility in predicting risk of severe asthma exacerbations. Methods Individuals were participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE), and those included in the current analysis had the following characteristics: age ≥18 years, physician-diagnosed asthma, and longitudinal care received at a large health system in southeastern Michigan. Study participants underwent a baseline evaluation, which included answering the ACT. A severe asthma exacerbation was defined as one requiring oral steroids, an emergency department visit, or inpatient admission. Receiver-operator characteristic curves were used to measure and compare the predictive utility of the ACT and its component questions for severe asthma exacerbations. Results Of 1,180 participants, 354 (30.0%) experienced a severe asthma exacerbation within 6 months of their baseline evaluation. When compared with the individual questions that composed the ACT, the composite score was significantly better at predicting severe exacerbations with one exception; the composite ACT score and the question assessing rescue medication use were not significantly different (P=0.580). Pharmacy-based records of metered-dose inhaler short-acting beta-agonist use and asthma severity were also not significantly different from the composite ACT score. Conclusion Our study demonstrates that while the ACT is modestly predictive for exacerbations, the composite score may not be superior to assessing rescue medication use alone for predicting risk of severe asthma exacerbations.

RATIONALE: The estimated prevalence of aspirin exacerbated respiratory disease (AERD) among asthma patients is 10-20%. There is no ICD-code for AERD. We sought to estimate AERD prevalence among asthma patients seen at Allergy, ENT, and Pulmonary Clinics at Montefiore Medical Center using a combination of specific diagnoses confirmed by a symptom-based questionnaire. METHODS: Patients seen between 2008-2013 with a combination of ICD-9 diagnoses of asthma, nonsteroidal anti-inflammatory drugs (NSAID) allergy, and either nasal polyps or chronic rhinosinusitis were identified. A questionnaire to assess AERD-related symptoms was administered via telephone. RESULTS: 4064 patients had ICD-9 diagnoses of asthma. Of these, 232 (7%) had ICD-9 diagnoses of NSAID allergy and either nasal polyps or chronic rhinosinusitis. One hundred forty-one patients agreed to participate in telephone interviews. The majority was female (82%), with mean age 52 (+/-SD 15). Sixty-five patients were categorized as ''likely having AERD'' based on reported asthma attacks with NSAID ingestion. The estimated AERD prevalence among asthma patients at Montefiore was 1.6%. Thirty-three patients (51%) with historicallydiagnosed AERD reported frequent sinus infections, 31 patients (48%) had > _1 sinus surgery, and 34 patients (54%) had poor or no sense of smell. Seventy-six patients reporting stomach pain, hives or angioedema, and no asthma symptoms after NSAID ingestion were identified as ''not having AERD''. CONCLUSIONS: The estimated low AERD prevalence among patients with asthma indicates that AERD is not a simple combination of diagnoses and is likely underdiagnosed. Introducing AERD-specific ICD code could raise awareness about this condition and lead to appropriate treatment choices (aspirin desensitization).