Susceptibility to exacerbations in Black adults with asthma |
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| Authors: | Nicole L. Grossman Gheorghe D. Doros Nicolas Fandino Anne L. Fuhlbrigge Wilson D. Pace Michael E. Wechsler |
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| Affiliation: | 1. Lahey Hospital and Medical Center, Burlington, MA, USA;2. Harvard Clinical Research Institute, Boston, MA, USA;3. Brigham and Women’s Hospital, Boston, MA, USA;4. School of Medicine, University of Colorado, Aurora, CO, USA;5. American Academy of Family Physicians, Shawnee Mission, KS, USA;6. National Jewish Health, Denver, CO, USA |
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| Abstract: | Objective: Exacerbations account for much of the morbidity in asthma. In a large intervention study, we sought to test the hypothesis that a Black adult exacerbation-prone phenotype – a group of Black people with asthma who are at high risk of repeat exacerbation within one year – exists in asthma independent of clinical control. Methods: We analyzed exacerbation risk factors in 536 self-identified Black Americans with asthma eligible for, or on, Step 3 National Asthma Education and Prevention Program (NAEPP) therapy who participated in a randomized 6–18?month trial of tiotropium versus long acting beta agonist as add-on therapy to inhaled corticosteroids. Exacerbations were defined as events treated by oral or systemic corticosteroids. Clinical control was assessed by a validated asthma control questionnaire (ACQ5). Results: Exacerbations became more likely with loss of clinical control. The mean baseline ACQs for exacerbators and non-exacerbators were 2.41 and 1.91, respectively (p?p?Conclusions: Even though exacerbations increase with loss of clinical control, an exacerbation susceptibility phenotype exists in Black adults with asthma, independent of clinical control. This phenotype requires precision therapeutic targeting. |
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| Keywords: | Asthma exacerbation prone phenotype clinical control corticosteroid exacerbation history Black American |
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