Ethnic-Specific Differences in Bronchodilator Responsiveness Among African Americans, Puerto Ricans, and Mexicans with Asthma

Abstract

Socioeconomic and environmental differences do not fully explain differences in asthma prevalence, morbidity, and mortality among Puerto Ricans, African Americans, and Mexican Americans. Differences in response to albuterol may be a factor. We compared bronchodilator responsiveness between these three populations. All groups demonstrated below expected responsiveness. Puerto Ricans of all ages and African American children with moderate-to-severe asthma demonstrated the lowest responsiveness overall. Among subjects with moderate-to-severe asthma, children were even less likely than adults to show the expected bronchodilator response. We conclude that ethnic-specific differences in bronchodilator drug responsiveness exist between Mexicans, Puerto Ricans, and African Americans with asthma. This may be of importance in asthma management.

Race, Ethnicity and Social Class and the Complex Etiologies of Asthma

“…However, the high prevalence is not universal in Hispanic and Asian subgroups; it is lowest in Mexicans and Koreans [8]. Mortality rates follow similar trends [3,10] and response to albuterol, the most commonly prescribed treatment for asthma, is lower in Puerto Ricans than in African Americans and Mexicans [1,5]. Unfortunately, with respect to asthma, racial and ethnic minorities have been largely understudied and often distinctions and heterogeneity within racial and ethnic groups are ignored.…”

“…These factors may confound asthma research resulting in inaccurate reporting of asthma prevalence and morbidity. Despite these limitations, there are well-documented disparities among racial and ethnic groups with respect to asthma prevalence, mortality and drug response [1][2][3][4][5][6][7].…”

The Brussels Declaration: the need for change in asthma management

“…Another example is the demand in many efficacy studies for 12-15% reversibility with a bronchodilator, yet many patients do not achieve this and are therefore excluded. By selecting patients on the basis of their response to a b 2 -adrenoceptor agonist for inclusion in trials will automatically lead to a bias in the subpopulation studied, especially in the knowledge that for this measure there are ethnic [61], age-related [62,63] and genetic variations [64]. Therefore, the current evidence base used in asthma management guidelines obtained largely from company-sponsored efficacy trials are far from ideal for recommending asthma therapy in the real-world setting.…”

Childhood Asthma Management and Environmental Triggers

“…In addition, Puerto Rican participants in the GALA study were less bronchodilator responsive after administration of a short-acting bronchodilator. 15 …”