Maintenance and rescue inhalers are a mainstay of treatment for persons living with asthma. Doctors at Washington University and St. Louis Children’s Hospital are part of a nationwide study to find out how to help black patients maintain better control with low-dose medication – and for good reason: asthma has a significant impact on the health of African Americans in this region.
“There is more asthma in the African American population and just the fact that more people have asthma, they have more urgent care…higher disease rates and they are hospitalized more often,” said Leonard B. Bacharier, M.D., a pediatric allergist and immunologist at St. Louis Children’s and Barnes-Jewish West hospitals and Washington University. “They have a death rate that is substantially higher than Caucasians.”
The study, The Best African American Response to Drugs, or BARD study, is through the National Institutes of Health’s multicenter asthma program, AsthmaNet.
This study is focusing on the response of African Americans with asthma, because they may respond differently to asthma medication.
“African Americans may respond differently to the conventional asthma therapies we use,” Dr. Bacharier explained, and there is a precedent for differing responses in other health conditions. “We know that managing African Americans with high blood pressure or heart failure really requires a different strategy than managing the same conditions in Caucasians, and there is no reason that asthma would be expected to behave different.”
Researchers want to enroll 50 to 60 study participants locally out of approximately 500 nationwide.
“We are trying to come up with a strategy that will allow us to deliver the best care to all African American patients whose asthma is not well controlled on standard line therapy,” Bacharier said. He is partnering with adult pulmonologist and internist Mario Castro, M.D. of Barnes-Jewish hospitals and Washington University for the adult portion of the research.
Researchers are looking for persons who identify themselves as African American, who have asthma and are on medication, ages 5 and older to come in for evaluation.
“Based on the amount of asthma therapy they are already receiving, they would leave for a period of weeks, on less asthma therapy than they came in on, to try to get everybody down to the same amount of asthma therapy, if possible,” Bacharier said. All medications used are standard, well-accepted FDA-approved medicine, nothing experimental or placebo, he added. Flovent and Advair are the asthma drugs being used in this study.
Once doctors find patients have asthma that is not adequately managed with first line therapy, which is a low-dose inhaled steroid, Bacharier said they would randomly be assigned through one of a series of therapy options in the study; changing their regimen every few months throughout the duration of the study.
“They would receive four different medication approaches, and then we’d examine which of these approaches did the best job for the individual patient and the population as a whole,” Bacharier explained.
Eventually everyone gets all of the options: a higher dose of the inhaled steroid; the addition of a long-acting bronchodilator; or the higher dose of the inhaled steroid and the addition of the long-acting bronchodilator.
The BARD asthma study will last about 16 months. It will include breathing tests, blood and urine samples, sputum induction, physical exam questionnaires and study medication. For participation, up to $1,250 will be offered to study participants for time and effort.
“This is the first study that we know of in asthma being done exclusively in African Americans with a focus on their needs and how to deliver the best care for them,” Bacharier said.
While African Americans have always been included in studies, Bacharier said they only make up about 30 to 35 percent of the study population.
“With those smallish number, we can’t always easy to ask the right questions, and ask them well enough to know we got the right answers,” Bacharier said. “This is really an opportunity for us to understand asthma in African Americans and understand how we as health care providers should be tailoring our approach to caring for them, based on their characteristics and not what we learn in bigger studies of very mixed populations.”
For more information on the pediatric asthma study, contact the BARD study coordinator at 314-286-1173 or toll free 1-866-841-2273.
For more information on the adult BARD asthma study, contact 314-362-1000 or email rprstaff@wustl.edu.
