Department of Internal Medicine, Henry Ford Health System, Detroit, MI 48202, USA.
J Allergy Clin Immunol. 2010 Dec;126(6):1131-8. doi: 10.1016/j.jaci.2010.08.002.
African American patients disproportionately experience uncontrolled asthma. Treatment with an inhaled corticosteroid (ICS) is considered first-line therapy for persistent asthma.
We sought to determine the degree to which African American patients respond to ICS medication and whether the level of response is influenced by other factors, including genetic ancestry.
Patients aged 12 to 56 years who received care from a large health system in southeast Michigan and who resided in Detroit were recruited to participate if they had a diagnosis of asthma. Patients were treated with 6 weeks of inhaled beclomethasone dipropionate, and pulmonary function was remeasured after treatment. Ancestry was determined by genotyping ancestry-informative markers. The main outcome measure was ICS responsiveness defined as the change in prebronchodilator FEV(1) over the 6-week course of treatment.
Among 147 participating African American patients with asthma, average improvement in FEV(1) after 6 weeks of ICS treatment was 11.6%. The mean proportion of African ancestry in this group was 78.4%. The degree of baseline bronchodilator reversibility was the only factor consistently associated with ICS responsiveness, as measured by both an improvement in FEV(1) and patient-reported asthma control (P = .001 and P = .021, respectively). The proportion of African ancestry was not significantly associated with ICS responsiveness.
Although baseline pulmonary function parameters appear to be associated with the likelihood to respond to ICS treatment, the proportion of genetic African ancestry does not. This study suggests that genetic ancestry might not contribute to differences in ICS controller response among African American patients with asthma.
非裔美国人患者的哮喘控制率明显较低。吸入皮质类固醇（ICS）治疗被认为是持续性哮喘的一线治疗方法。
我们旨在确定非裔美国患者对 ICS 药物的反应程度，以及反应程度是否受到其他因素的影响，包括遗传背景。
我们招募了在密歇根州东南部的一家大型医疗系统接受治疗且居住在底特律的年龄在 12 至 56 岁之间的非裔哮喘患者。患者接受了 6 周的丙酸倍氯米松吸入治疗，治疗后重新测量肺功能。通过基因分型遗传标记来确定祖源。主要观察指标是 ICS 反应性，定义为治疗 6 周内预支气管扩张剂 FEV1 的变化。
在 147 名患有哮喘的非裔美国患者中，ICS 治疗 6 周后 FEV1 的平均改善量为 11.6%。该组的平均非洲裔祖源比例为 78.4%。在基线时支气管扩张剂的可逆性是唯一与 ICS 反应性一致相关的因素，无论是通过 FEV1 的改善还是患者报告的哮喘控制情况来衡量（P=0.001 和 P=0.021）。非洲裔祖源比例与 ICS 反应性无显著相关性。
尽管基线肺功能参数似乎与对 ICS 治疗反应的可能性相关，但遗传非洲裔祖源比例则不然。本研究表明，遗传背景可能不会导致非裔美国哮喘患者对 ICS 控制药物的反应存在差异。
