Adding Inhaled Glucocorticoid May Relieve Asthma Burden in Black, Latinx Patients

Using an inhaled glucocorticoid in addition to usual care reduced the rate of severe asthma exacerbations and improved other markers of disease severity.

Adding an inhaled glucocorticoid to usual care for Black and Latinx patients with moderate-to-severe asthma may improve their condition, suggest new study findings, with the researchers emphasizing the importance of reducing the disproportionate burden of asthma facing these patients.

In a cohort of over 1200 Black and Latinx adult patients with moderate-to-severe forms of the condition, using an inhaled glucocorticoid, after one-time instructions on how to use, in addition to usual care reduced the rate of severe asthma exacerbations—the primary endpoint—and improved other markers of disease severity.

Half of the group received the experimental treatment approach while the other half received usual care alone. Patients also receiving the glucocorticoid had an annualized rate of severe asthma exacerbations of 0.69 (95% CI, 0.61-0.78), compared with 0.82 (95% CI, 0.73-0.92) among patients receiving usual care alone (HR, 0.85; 95% CI, 0.72-0.999; P = .048). The researchers noted that this difference remained consistent throughout the open-label study.

“Reducing disparities in asthma morbidity in Black and Latinx populations has been difficult. In this trial involving an ethnically diverse population of Black and Latinx patients with moderate-to-severe asthma and multiple coexisting conditions, the provision of inhaled glucocorticoid with instructions for use triggered by quick-reliever use (PARTICS), added to existing usual care, led to a lower risk of severe asthma exacerbations,” wrote the researchers, suggesting, “Such a strategy may be easy to implement in populations with disproportionate asthma morbidity, as we continue to assess the effectiveness of additional interventions in diverse populations.”

Exploring the impact on Asthma Control Test and Asthma Symptom Utility Index scores—secondary endpoints of the trial—the researchers found that added glucocorticoid was consistently associated with more significant increases. Scores increased by 3.4 points (above the minimal clinically important difference of 3 points) and 0.12 points (above the minimal clinically important difference of 0.09 points), respectively, for patients receiving the glucocorticoid and by 2.5 points and 0.08 points, respectively, for patients receiving usual care.

Post hoc analyses showed that patients receiving the glucocorticoid spent a mean 0.75 months per year in the emergency department or at urgent care, with 70 asthma-related hospitalizations reported. Patients receiving usual care alone spent a mean of 0.90 months per year in the emergency department or at urgent care, with 84 asthma-related hospitalizations reported.

Findings from the post hoc analyses also showed that patients receiving the intervention had an 18% lower rate of quick-reliever inhaler refills and had 32% fewer months of quick-reliever nebulizer use. The researchers highlighted the importance of this finding, as some research has pointed to an association between frequency of β2-agonist quick-reliever use and mortality.

“The broad entry criteria and design of this trial could have reduced the apparent effectiveness of the patient-activated, reliever-triggered inhaled glucocorticoid strategy,” flagged the researchers. “We did not require evidence of bronchodilator responsiveness, we enrolled current and former smokers, and we did not require all participants to have had an exacerbation in the previous year. Application of these criteria to entry would have enriched the trial for a population with a greater response to inhaled glucocorticoids, a factor that is also suggested by our interaction analysis.”

Throughout the study, 12.2% of patients experienced serious adverse events—most commonly asthma (7.2%), infection or infestation (1.6%), and cardiac events (1.5%)—with no significant differences between the 2 groups.

Reference

Israel E, Cardet J, Carroll J, et al. Reliever-triggered inhaled glucocorticoid in Black and Latinx adults with asthma. N Engl J Med. 2022;386:1505-1518.
doi: 10.1056/NEJMoa2118813.