Hardie Grace, Liu Rebecca, Darden Jennifer, Gold Warren M
San Francisco State University, School of Nursing, San Francisco, California 94132, USA.
J Asthma. 2010 May;47(4):388-96. doi: 10.3109/02770903.2010.481341.
There is little asthma research that compares ethnic differences in airway responsiveness and word descriptors among African Americans, Hispanic-Mexican Americans, Asian-Pacific Islanders, and Whites. Thus, identifying ethnic differences in symptom descriptors and airway responsiveness may improve health outcomes by educating health professionals about treatment decisions that are culturally and ethnically sensitive.
Specific Inclusion criteria-forced expiratory volume in one second (FEV(1)) >or= 70% predicted normal; provocative concentration causing a 30% fall in FEV(1) (PC(30)) <or= 8 mg/ml for methacholine (MCh), using only a beta(2)- inhaler, and self-reported ethnicity of African American, Hispanic-Mexican American, Asian-Pacific Islander, or White. Serial pulmonary function test (PFT) and Borg, Visual Analogue Scale (VAS), and Ethnic Word Descriptors (EWDs) were collected.
One hundred eighteen consented, 106 completed procedures, and 90 had a positive PC(30) and were enrolled. Asian-Pacific Islanders had significantly greater airway responsiveness (p <.02). Baseline FEV(1), MCh dose, and PC(30) correlated with race (p <.001); baseline FEV(1) and ethnicity predicted airway responsiveness (p <.001). EWDs differed significantly by ethnicity. Upper airway EWDs for Asian-Pacific Islanders: itchy throat (p < .04), itchy (p <.02), itchy back throat (p <.04), voice tight, tight throat (p <.001), and cough (p <.04). Upper airway EWDs for African Americans: add itchy throat (p <.002), itchy neck (p <.001), tight throat (p <.003), voice tight (p <.02), and cough (p <.04). Hispanic-Mexican Americans used both upper and lower airway EWDs; Whites used only lower airway EWDs.
This study provides new insights about ethnic differences in airway responsiveness and EWDs. Asian-Pacific Islanders required a significantly smaller dose of MCh to achieve a PC(30) compared to the other three ethnic groups. The upper airway EWDs used by African Americans, Asian-Pacific Islanders, and Hispanic-Mexican Americans indicate a shared language of symptoms. A new language of breathlessness that incorporates both cultural and ethnic differences is needed to address the present disparity in the management of asthma symptoms.
很少有哮喘研究比较非裔美国人、西班牙裔墨西哥裔美国人、亚太岛民和白人在气道反应性和症状描述词方面的种族差异。因此，识别症状描述词和气道反应性方面的种族差异，通过让医疗专业人员了解具有文化和种族敏感性的治疗决策，可能会改善健康结果。
具体纳入标准——一秒用力呼气容积（FEV(1)）≥预测正常值的70%；使用仅一种β(2)吸入器时，乙酰甲胆碱（MCh）诱发FEV(1)下降30%的激发浓度（PC(30)）≤8mg/ml，且自我报告的种族为非裔美国人、西班牙裔墨西哥裔美国人、亚太岛民或白人。收集系列肺功能测试（PFT）、博格视觉模拟量表（VAS）和种族症状描述词（EWD）。
118人同意参与，106人完成程序，90人PC(30)呈阳性并被纳入研究。亚太岛民的气道反应性显著更高（p<.02）。基线FEV(1)、MCh剂量和PC(30)与种族相关（p<.001）；基线FEV(1)和种族可预测气道反应性（p<.001）。EWD因种族不同而有显著差异。亚太岛民的上呼吸道EWD：喉咙痒（p<.04）、痒（p<.02）、喉咙后部痒（p<.04）、声音发紧、喉咙发紧（p<.001）和咳嗽（p<.04）。非裔美国人的上呼吸道EWD：增加喉咙痒（p<.002）、脖子痒（p<.001）、喉咙发紧（p<.003）、声音发紧（p<.02）和咳嗽（p<.04）。西班牙裔墨西哥裔美国人同时使用上呼吸道和下呼吸道EWD；白人仅使用下呼吸道EWD。
本研究提供了关于气道反应性和EWD种族差异的新见解。与其他三个种族群体相比，亚太岛民达到PC(30)所需的MCh剂量显著更小。非裔美国人、亚太岛民和西班牙裔墨西哥裔美国人使用的上呼吸道EWD表明存在共同的症状语言。需要一种融合文化和种族差异的新的呼吸困难语言，以解决目前哮喘症状管理方面的差异。
