种族/民族特异性差异对哮喘患者吸入皮质类固醇对支气管扩张剂反应的影响。

Racial/Ethnic-Specific Differences in the Effects of Inhaled Corticosteroid Use on Bronchodilator Response in Patients With Asthma.

机构信息

Department of Medicine, University of California, San Francisco, California, USA.

Department of Bioengineering and Therapeutic Sciences, University of California, San Francisco, California, USA.

出版信息

Clin Pharmacol Ther. 2019 Nov;106(5):1133-1140. doi: 10.1002/cpt.1555. Epub 2019 Jul 23.

Abstract

American Thoracic Society guidelines recommend inhaled corticosteroid (ICS) therapy, plus a short-acting bronchodilator, in patients with persistent asthma. However, few prior studies have examined the efficacy of this combination in children of all racial/ethnic groups. We evaluated the association between ICS use and bronchodilator response (BDR) in three pediatric populations with persistent asthma (656 African American, 916 Puerto Rican, and 398 Mexican American children). The association was assessed using multivariable quantile regression. After adjusting for baseline forced expiratory volume in one second and use of controller medications, ICS use was significantly associated with increased BDR only among Mexican Americans (1.56%, P = 0.028) but not African Americans (0.49%, P = 0.426) or Puerto Ricans (0.16%, P = 0.813). Our results demonstrate that ICS augmentation is disproportionate across racial/ethnic groups, where improved BDR is observed in Mexican Americans only. This study highlights the complexities of treating asthma in children, and reinforces the importance of investigating the influence of race/ethnicity on pharmacological response.

摘要

美国胸科学会指南建议持续性哮喘患者使用吸入性皮质类固醇(ICS)联合短效支气管扩张剂治疗。然而,此前很少有研究调查过ICS 联合治疗方案在所有种族/民族群体儿童中的疗效。我们评估了 ICS 使用与支气管扩张剂反应(BDR)之间的关联,共纳入了三组持续性哮喘的儿科人群(656 名非裔美国人、916 名波多黎各人和 398 名墨西哥裔美国人)。采用多变量分位数回归评估了这种关联。在调整了基线一秒用力呼气容积和控制器药物使用后,ICS 使用与 BDR 增加显著相关,仅在墨西哥裔美国人中存在显著相关性(增加 1.56%,P=0.028),而非在非裔美国人(增加 0.49%,P=0.426)或波多黎各人(增加 0.16%,P=0.813)中存在相关性。我们的研究结果表明,ICS 增强作用在不同种族/民族群体中存在差异,仅在墨西哥裔美国人中观察到 BDR 改善。本研究突出了儿童哮喘治疗的复杂性,并强调了研究种族/民族对药物反应影响的重要性。

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