Doctors may need to ‘step up’ asthma treatment for African American children

New study finds black children ages 5-11 may respond differently than older kids and adults, and than white children

For people with allergies, ragweed can be more than uncomfortable: In severe cases, it can be deadly.

Deaths from asthma are disproportionately higher among black patients than among white patients, but black patients constitute the minority of participants in trials informing treatment.

As a result, recommended treatments might not work well enough for African Americans.

A new study published in the New England Journal of Medicine conducted trials on two groups that suffered from inadequately controlled asthma: African American children, and black adolescents and adults.

The researchers examined how to “escalate or ‘step-up’ asthma treatments for African Americans whose asthma had not been treated adequately with low doses of inhaled corticosteroids, the standard starting treatment.”

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The treatment options were: increase the dosage of the inhaled steriod; add a long-lasting bronchodilator, which opens airways; or both.

Researchers said they expected the increased steroid dosage would do the trick, but found that either approach worked for the children: Nearly half (46%) responded better to increasing the inhaled corticosteroid dose alone and just as many (46%) responded better to increasing the inhaled corticosteroid dose and adding a long-lasting bronchodilator. These results differed from how the black adolescents and adults responded, and how white children and adults responded in other trial studies.

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“We shouldn't assume that current treatment strategies for asthma are ideal for all African Americans since for many years that population was not adequately represented in research,” wrote Elliot Israel, senior study author and director of clinical research in Pulmonary and Critical Care Medicine Division at Brigham and Women's Hospital. “We found that almost half of the African American children studied responded better to increasing the dose of inhaled corticosteroids than adding a long-acting bronchodilator. Thus, adding a long-acting bronchodilator may not be the right answer for nearly half of African American children."

"This study is an important step in the direction of providing personalized asthma care to patients both by examining racial disparities and by identifying differences in treatment responses between children and adults with asthma," study co-author Rachel Robinson told Medical Life Sciences.

The study was funded by the National Heart, Lung, and Blood Institute, part of the National Institutes of Health.