Race is associated with differences in airway inflammation in patients with asthma.

BACKGROUND: African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. OBJECTIVE: We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS-, respectively). METHODS: We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute-sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. RESULTS: Among 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P < .01), greater total IgE levels (197 vs 120 IU/mL, P < .01), and a greater proportion with uncontrolled asthma (43% vs 28%, P < .01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS- group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P = .28; ICS- group: 39% vs 35%, P = .65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P = .046) but not in the ICS- group (P = .984). CONCLUSION: African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.

Biomarkers in asthmatic patients: Has their time come to direct treatment?

Asthma is a heterogeneous disease with multiple phenotypes that have variable risk factors and responses to therapeutics. Mild-to-moderate asthma often responds to traditional medications, whereas severe disease can be refractory to inhaled corticosteroids, long-acting ß-agonists, and leukotriene receptor antagonists. There is robust research into the variable phenotypes of asthma. Biomarkers help define the specific pathophysiology of different asthma phenotypes and identify potential therapeutic targets. The following review will discuss the current use of biomarkers for the diagnosis of asthma, triaging the severity of a patient's disease, and the potential efficacy of treatments. This information can be used to define certain patient populations that are more likely to respond to inhaled corticosteroids or biologics. As knowledge of patient phenotypes and endotypes and biological agents to target specific classes of asthma emerge, the ability to provide personalized care to asthmatic patients will follow.

Evaluation of the Effectiveness of a Patient-Centered Educational Mailer Designed to Improve Statin Adherence: A Pragmatic Trial.

BACKGROUND: Patients with high total cholesterol have increased risk of cardiovascular disease. National Cholesterol Education Program (NCEP) and American Heart Association (AHA) guidelines recommend cholesterol lowering with statin medications; however, statin adherence remains poor. We hypothesized that patient-centered education on the 10-year risk for each of the major constituents of cardiovascular disease would increase statin adherence and achievement of the low-density lipoprotein cholesterol (LDL-C) goal. METHODS: Veterans within the Salt Lake City Veterans Affairs (VA) Medical Center initiating statin therapy from October 2008 to December 2011 were randomized in a pragmatic design to receive either an educational mailer or usual care. The mailer outlined their 10-year global cardiovascular risk, separated into coronary heart disease, stroke, and congestive heart failure. The study was unblinded and followed an intention-to-treat analysis where outcome measures were obtained during normal care process. The primary outcome measure was the achievement of the LDL-C goal during the 12-month follow-up. RESULTS: Two hundred and seven patients were randomly assigned to either the intervention arm (95) or the control arm (112). No differences in the proportion of patients meeting the LDL-C goal were detected during 12-months [Relative Risk (RR): 0.95 (95 percent confidence interval (CI): 0.77-1.17)] or 18-months [RR: 1.03 (95 percent CI: 0.84, 1.25)]. Patients in the intervention arm had higher adherence on average, e.g., intervention patients were more likely to have 70 percent or more days of statin therapy compared to patients who received standard care-though this did not reach statistical significance-RR: 1.33 (95 percent CI: 1.00, 1.78). There were no statistical differences in cardiovascular outcomes or mortality. CONCLUSION: Patient education mailers sent to patients starting statin treatment did not have a clear impact on LDL-C goal achievement or adherence to statin therapy.