Wells Karen E, Cajigal Sonia, Peterson Edward L, Ahmedani Brian K, Kumar Rajesh, Lanfear David E, Burchard Esteban G, Williams L Keoki
Department of Public Health Sciences, Henry Ford Health System, Detroit, Mich.
Department of Internal Medicine, Henry Ford Health System, Detroit, Mich.
J Allergy Clin Immunol. 2016 May;137(5):1364-1369.e2. doi: 10.1016/j.jaci.2015.12.1334. Epub 2016 Mar 22.
Inhaled corticosteroids (ICSs) 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.
We sought to assess behavioral, sociodemographic, and genetic factors related to ICS response among African American and European American subjects with asthma.
Study participants were part of the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-ethnicity (SAPPHIRE). The analytic sample included asthmatic subjects aged 12 to 56 years with greater than 12% bronchodilator reversibility and percent predicted FEV1 of between 40% and 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 a change in prebronchodilator FEV1. Adherence was measured with electronic monitors. Genetic ancestry was estimated for African American participants by using genome-wide genotype data.
There were 339 study participants; 242 self-identified as African American and 97 as European American. Baseline ACT score, percent predicted FEV1, degree of bronchodilator response, and ICS adherence were significantly associated with ICS response. A baseline ACT score of 19 or less 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.
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.
吸入性糖皮质激素（ICSs）是实现哮喘控制的首选治疗方法。然而，关于影响治疗反应的因素以及治疗反应是否因人群组而异，我们知之甚少。
我们试图评估与非裔美国人和欧洲裔美国人哮喘患者ICS反应相关的行为、社会人口统计学和遗传因素。
研究参与者是种族-族裔哮喘表型和药物基因组相互作用研究（SAPPHIRE）的一部分。分析样本包括年龄在12至56岁之间、支气管扩张剂可逆性大于12%且预测FEV1百分比在40%至90%之间的哮喘患者。参与者接受了6周的吸入性二丙酸倍氯米松治疗。ICS反应的主要指标是哮喘控制测试（ACT）评分的变化；次要指标是支气管扩张剂前FEV1的变化。使用电子监测器测量依从性。通过使用全基因组基因型数据估计非裔美国参与者的遗传血统。
共有339名研究参与者；242人自我认定为非裔美国人，97人自我认定为欧洲裔美国人。基线ACT评分、预测FEV1百分比、支气管扩张剂反应程度和ICS依从性与ICS反应显著相关。基线ACT评分为19或更低有助于识别那些会有反应的人，与ICS依从性的显著剂量反应关系证明了这一点。所有参与者的自我报告种族-族裔以及非裔美国参与者中的非洲血统比例均与ICS反应性无关。
我们的研究结果表明，基线肺功能测量和自我报告的哮喘控制可预测ICS反应，而自我报告的种族-族裔和遗传血统则不能。
