Improving Asthma Control in Patients of Hispanic & African Americans

Interview with Grace E. Hardie, PhD, RN, UCSF, SF State Associate Professor San Francisco State University

Our understanding of how ethnicity influences how patients describe their asthma symptoms and how ethnicity impacts airway responsiveness is extremely limited. Ethnic influences on symptom
description and airway responsiveness were the subject of a 2010 study of induced bronchoconstrictor administration in African Americans and Hispanic, Latino & Mexican Americans with mild asthma (Journal of Asthma, 2010; 47:1-9).

If healthcare professionals are better able to understand the ethnic differences in symptom descriptors and airway responsiveness, then treatment decisions that are both culturally and ethnically sensitive may be applied and outcomes may be improved.

Using a standardized methacholine (McH)challenge (bronchoconstrictor) procedure a doubling dose (0.078-10mg/ml) of McH was used that would result in a 30% fall (PC30) in FEV1. Mild asthma was defined as FEV1?70% of predicted. Baseline FEV1 was comparable for both groups. Mean age of African Americans was 30.3 y and mean age of Hispanic/Latino/Mexican Americans was 30.9 y. Ethnic differences in both airway hyperresponsiveness and symptom presentation were documented. The dose of McH at PC30 for African Americans was 2.6 mg/ml; Hispanic, Latino & Mexican Americans was 2.62 mg/ml. The dose of McH at PC30 reflects the significance of the degree of airway hyperresponsiveness experienced by both ethnic groups during episodes of acute asthma. African Americans used only upper airway ethnic word descriptors (EWD) at PC30 including itchy throat, tight throat, voice tight, & itchy neck. Hispanic-Mexican Americans at PC30 used both upper and lower airway EWDs to describe their symptoms:

Upper airway: voice tight, itchy throat, itchy inside throat & chest, & tickle cough: Lower airway EWDs were-sore lung-chest, wheezing, can’t get air in/out. The EWDs reported and their differences across the differing ethnicities reflect the uniquely different perception of acute bronchoconstriction for each ethnic group. For the health professional, the EWDs provide an opportunity to expand our understanding of ethnic differences in symptom presentation and, also, to determine symptom management.

What is not fully understood is the relationship between EWDs, the regulation of beta-adrenergic airway responsiveness and ethnicity. The current word descriptors of wheezing, shortness of breath and chest tightness were derived from studies enrolling primarily Caucasian adults. These EWDs need to be expanded and revised to reflect our more diverse ethnic populations. As health care professionals asking your asthma patients what their primary asthma symptoms are when they seek care for an acute episode is an essential step forward if symptom management for all diverse ethnic groups are to be improved.

J Asthma. 2010 May;47(4):388-96. doi: 10.3109/02770903.2010.481341

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