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Published ahead of print on November 14, 2003, doi:10.1164/rccm.200309-1293OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 3, February 2004, 386-392

A more recent version of this article appeared on February 1, 2004
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Submitted on September 17, 2003
Accepted on November 12, 2003

LOWER BRONCHODILATOR RESPONSIVENESS IN PUERTO RICAN THAN IN MEXICAN ASTHMATIC SUBJECTS

Esteban Gonzales Burchard1*, Pedro C Avila2, Sylvette Nazario3, Jesus Casal3, Alfonso Torres3, Jose R Rodriguez-Santana4, Jody Senter Sylvia5, Joanne K Fagan6, Jorge Salas7, Craig M Lilly5, Elad Ziv2, Moises Selman7, Rocio Chapela7, Dean Sheppard1, Scott T Weiss5, Jean G Ford8, Homer A Boushey2, William Rodriguez-Cintron3, Jeffrey M Drazen5, and Edwin K Silverman5

1 Medicine, University of California, San Francisco, San Francisco, CA, USA; Lung Biology Center, San Francisco General Hospital, San Francisco, CA, USA, 2 Medicine, University of California, San Francisco, San Francisco, CA, USA, 3 Medicine, San Juan Veterans Administration Medical Center, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA, 4 Pediatric Pulmonology, University of Puerto Rico, San Juan, Puerto Rico, USA, 5 Medicine, Brigham and Women's Hospital, Boston, MA, USA, 6 Medicine, The Harlem Lung Center, Harlem Hospital and Columbia University, New York, NY, USA, 7 Medicine, Instituto Nacional de Enfermedades Respiratorias, Mexico City, D.F., Mexico, 8 Medicine, The Harlem Lung Center, Harlem Hospital and Columbia University, New York, NY, USA; Epidemiology, Johns Hopkins Bloomberg School of Public Health, Balitmore, MD, USA

* To whom correspondence should be addressed. E-mail: eburch{at}itsa.ucsf.edu.

In the U.S., Puerto Ricans and Mexicans, have the highest and lowest asthma prevalence, morbidity and mortality, respectively. To determine whether ethnic-specific differences in therapeutic response, clinical, and/or genetic factors contribute to differences in asthma outcomes, we compared asthma-related clinical characteristics among 684 Mexican and Puerto Rican asthmatics recruited from San Francisco, New York City, Puerto Rico and Mexico City. Asthmatic Puerto Ricans had reduced lung function, greater morbidity, and longer asthma duration than asthmatic Mexicans. Bronchodilator responsiveness, measured as percentage change from baseline FEV1, was significantly lower among asthmatic Puerto Ricans than Mexicans. Asthmatic Puerto Ricans had on average 7.3% (95% CI: 4.6, 9.9; p<0.001) lower bronchodilator reversibility in FEV1, higher risk of an Emergency Department visit in the previous year (OR=2.63, 95%CI=1.6-4.3, p<0.001), and of previous hospitalization for asthma (OR = 1.94, 95%CI = 1.2-3.2, p = 0.009) than Mexicans. Subgroup analysis corroborated that asthmatic Puerto Ricans had more severe disease than Mexicans based on lung function measurements, responsiveness to b2-adrenergic agonists, and health care utilization. We conclude that asthmatic Puerto Ricans respond less to albuterol than asthmatic Mexicans. These findings underscore the need for additional research on racial/ethnic differences in asthma morbidity and response to therapy.
Key words: Asthma, clinical characteristics, bronchodilator, Mexican, Puerto Ricans




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