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Lower Bronchodilator Responsiveness in Puerto Rican than in Mexican Subjects with Asthma

University of California, San Francisco; Lung Biology Center, San Francisco General Hospital, San Francisco, California; San Juan Veterans Affairs Medical Center, University of Puerto Rico School of Medicine; Division of Pediatric Pulmonology, University of Puerto Rico, San Juan, Puerto Rico; Brigham and Women's Hospital, Boston, Massachusetts; Harlem Lung Center, Harlem Hospital and Columbia University, New York, New York; and Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico

Correspondence and requests for reprints should be addressed to Esteban González Burchard, M.D., University of California, San Francisco, San Francisco, CA 94143-0833. E-mail: eburch{at}itsa.ucsf.edu

In the United States, Puerto Ricans and Mexicans have the highest and lowest asthma prevalence, morbidity, and mortality, respectively. To determine whether ethnicity-specific differences in therapeutic response, clinical response, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican individuals with asthma recruited from San Francisco, New York City, Puerto Rico, and Mexico City. Puerto Ricans with asthma had reduced lung function, greater morbidity, and longer asthma duration than did Mexicans with asthma. Bronchodilator responsiveness, measured as percentage change from baseline FEV₁, was significantly lower among Puerto Ricans with asthma than among Mexicans with asthma. Puerto Ricans with asthma had on average 7.3% (95% confidence interval [CI], 4.6 to 9.9; p < 0.001) lower bronchodilator reversibility in FEV₁, higher risk of an emergency department visit in the previous year (odds ratio, 2.63; 95% CI, 1.6 to 4.3; p < 0.001), and of previous hospitalization for asthma (odds ratio, 1.94; 95% CI, 1.2 to 3.2; p = 0.009) than Mexicans. Subgroup analysis corroborated that Puerto Ricans with asthma had more severe disease than did Mexicans on the basis of lung function measurements, responsiveness to ß₂-adrenergic agonists, and health care use. We conclude that Puerto Ricans with asthma respond less to albuterol than do Mexicans with asthma. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.

Key Words: asthma • bronchodilator • clinical characteristics • Mexicans and Puerto Ricans

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