The addition of a long-acting beta-agonist to an inhaled corticosteroid did not improve the time to an asthma exacerbation in black adults with asthma vs. the addition of tiotropium, an anticholinergic, a study published in JAMA reports. 

Current treatment recommendations suggest increasing inhaled corticosteroid (ICS) dose or adding a long-acting beta-agonist (LABA) for patients with poor control on low-dose ICS. However, the safety of LABA therapy has been questioned with possible increases in serious events, including hospitalization and death. 

Recent research suggests that LABA risks may disproportionately affect black patients and that this population may not benefit as much from LABAs as other patients. Studies in predominately white populations have tried to determine if long-acting anticholinergics can substitute for LABAs in asthma. 

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In this study, researchers from Brigham and Women’s Hospital, Boston, MA and colleagues, randomized black adults with moderate to severe asthma to receive ICS + once-daily tiotropium (n=532) or twice-daily LABAs (n=538). Patients were given monthly questionnaires and were followed for up to 18 months. Genetic testing was also conducted in patients as some studies have suggested that a genetic variation may be associated with increased rates of adverse outcomes when LABAs are used to asthma, especially among black patients.

The study’s primary outcome, time to first exacerbation, was not significantly different between groups. LABA + ICS was not found to be superior to tiotropium + ICS for secondary outcomes that addressed additional dimensions of asthma control (eg, patient-reported outcomes, rescue medication use, asthma deteriorations). Study authors reported that genetic variants were not related to different responses to therapy

Study findings do not support the superiority of LABA + ICS vs. tiotropium + ICS for black patients with asthma, they concluded. Further targeted interventions and studies are needed to reduce the rate of asthma exacerbations in this population.

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