Poorly controlled asthma in black children may respond to increased dose of inhaled glucocorticoid
WEDNESDAY, Sept. 25, 2019 (HealthDay News) — In contrast to findings in black adolescents and adults, almost half of black children with poorly controlled asthma have a superior response to an increased dose of an inhaled glucocorticoid and almost half have a superior response to the addition of a long-acting beta-agonist (LABA), according to a study published in the Sept. 26 issue of the New England Journal of Medicine.
Michael E. Wechsler, M.D., from National Jewish Health in Denver, and colleagues conducted two randomized controlled trials, one involving children and the other involving adolescents and adults. Patients in both trials had one or more grandparents identified as black and had asthma that was inadequately controlled with low-dose inhaled glucocorticoids. Combinations of therapy were compared, including the addition of a LABA (salmeterol) to an inhaled glucocorticoid (fluticasone propionate), a step-up to double to quintuple the fluticasone dose, or both.
The researchers found a superior response in 46 percent of children with quintupling the fluticasone and in 46 percent of children with doubling the fluticasone and adding salmeterol (P = 0.99). More adolescents and adults had a superior response with the addition of salmeterol than increasing fluticasone (salmeterol + low-dose fluticasone versus medium-dose fluticasone: 49 versus 28 percent [P = 0.003]; salmeterol + medium-dose fluticasone versus high-dose fluticasone: 49 versus 31 percent [P = 0.02]).
“Outcomes differed in children and adults, and the results in these children differed from those previously reported in studies involving white children,” the authors write.
Several authors disclosed financial ties to the pharmaceutical industry.
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