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Asthma study, led by USF doctor, targets racial gaps in disease

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Year-long asthma trial led by University of South Florida researcher may point the way to closing the disease story racial gaps, according to results published on Saturday by the New England Journal of Medicine.

The study, which followed about 1,200 black and Latino asthma patients for more than a year, focused on one promising tactic: those who added an inhaled corticosteroid as needed, an anti-inflammatory drug, plus anything their doctor had previously prescribed, fared better than those who continued their usual diet.

According to the study, minimal use of the added drug – just over one inhaler per year, on average – led to fewer severe asthma symptoms, better quality of life and fewer sick days.

The results are significant in part because previous efforts to address racial health disparities among asthma patients have been largely unsuccessful, said Juan Carlos Cardet, an allergist-immunologist and assistant professor at USF, who was the lead author of the study. The study, which involved patients from the United States and Puerto Rico, listed nearly 50 co-authors.

Juan Carlos Cardet, an allergist-immunologist at the University of South Florida, is the lead author of a New England Journal of Medicine study of an asthma treatment that could help reduce racial disparities in the disease. [ University of South Florida ]

“The fact that we had a positive result…something that could improve people’s lives is a privilege,” Cardet said of the study, which spanned eight years.

Black Americans are dying from asthma at more than double the rate of white Americans, according to the Centers for Disease Control and Prevention. They are also about five times more likely to go to the emergency room or be hospitalized due to the disease. In Florida, emergency room visits, hospitalizations and deaths from asthma all occur three times faster for black residents than for white residents, according to data from the Department of Health.

In Pinellas County in 2020, the disparities in emergency and hospitalization rates were even greater, although the county’s disparity in death rates was less severe than the state average. Overall, Tampa Bay is one of the worst areas in the state for black asthma hospitalizations, with above-average rates in Pinellas, Hillsborough, Pasco, Hernando counties , Polk and Manatee.

Cardet’s research focused on how patients treat their asthma. Diets for asthma generally fall into two categories, he said: There are rescue medications – think of an inhaler ‘to be used as needed’.. So there is control or maintenance treatment, which requires regular and frequent use. The latter has been associated with lower death rates, Cardet said, but research has shown that black patients use controller medication much less often than white patients. Cardet and previous research have suggested many reasons for this, including barriers to accessing specialists, differences in patient communications with doctors, and disparities in health insurance.

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In a process that Cardet said was “unprecedented in the pharmaceutical industry,” a group of patients collaborated with researchers on the design of the trial. They checked the researchers’ language, helping to make it more understandable for average patients, adding new angles to the monthly surveys that participants would answer, and developing a system to personalize them. Cardet said the researchers found patients rarely used technical terms such as “salvage therapy”; instead, they could color-code their inhalers or give them nicknames, like “Bob” or “friend.”

“In a significant portion of cases there is miscommunication,” he said. “This mismatch in terminology, after controlling for 15 different variables, actually creates worse results.”

By cutting out the jargon — and giving patients the option to complete surveys by mail, phone or online — Cardet said researchers got more participant engagement and more accurate responses.

The next steps are to integrate the trial results in clinical practice, Cardet said.

“That’s actually a large decrease in asthma exacerbations and asthma morbidity in the healthcare system achieved by one inhaler per year per person,” he said.