Race is associated with differences in airway inflammation in patients with asthma

Sharmilee M. Nyenhuis; Jerry A. Krishnan; Alalia Berry; William J. Calhoun; Vernon M. Chinchilli; Linda Engle; Nicole Grossman; Fernando Holguin; Elliot Israel; Rick A. Kittles; Monica Kraft; Stephen C. Lazarus; Erik B. Lehman; David T. Mauger; James N. Moy; Stephen P. Peters; Wanda Phipatanakul; Lewis J. Smith; Kaharu Sumino; Stanley J. Szefler; Michael E. Wechsler; Sally Wenzel; Steven R. White; Steven J. Ackerman

doi:10.1016/j.jaci.2016.10.024

Race is associated with differences in airway inflammation in patients with asthma

Sharmilee M. Nyenhuis^*, Jerry A. Krishnan, Alalia Berry, William J. Calhoun, Vernon M. Chinchilli, Linda Engle, Nicole Grossman, Fernando Holguin, Elliot Israel, Rick A. Kittles, Monica Kraft, Stephen C. Lazarus, Erik B. Lehman, David T. Mauger, James N. Moy, Stephen P. Peters, Wanda Phipatanakul, Lewis J. Smith, Kaharu Sumino, Stanley J. SzeflerMichael E. Wechsler, Sally Wenzel, Steven R. White, Steven J. Ackerman

^*Corresponding author for this work

Medicine, Pulmonary Division

Research output: Contribution to journal › Article › peer-review

28 Scopus citations

Abstract

Background African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. Objective We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS−, respectively). Methods We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute–sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. Results Among 1018 participants, African American subjects (n = 264) had a lower FEV₁ percent predicted (80% vs 85%, P <.01), greater total IgE levels (197 vs 120 IU/mL, P <.01), and a greater proportion with uncontrolled asthma (43% vs 28%, P <.01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS− group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P =.28; ICS− group: 39% vs 35%, P =.65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P =.046) but not in the ICS− group (P =.984). Conclusion African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.

Original language	English (US)
Pages (from-to)	257-265.e11
Journal	Journal of Allergy and Clinical Immunology
Volume	140
Issue number	1
DOIs	https://doi.org/10.1016/j.jaci.2016.10.024
State	Published - Jul 2017

Keywords

African American
Asthma
airway inflammation
body mass index
clinical trial
corticosteroid
eosinophil
induced sputum
race

ASJC Scopus subject areas

Immunology and Allergy
Immunology

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10.1016/j.jaci.2016.10.024

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Nyenhuis, S. M., Krishnan, J. A., Berry, A., Calhoun, W. J., Chinchilli, V. M., Engle, L., Grossman, N., Holguin, F., Israel, E., Kittles, R. A., Kraft, M., Lazarus, S. C., Lehman, E. B., Mauger, D. T., Moy, J. N., Peters, S. P., Phipatanakul, W., Smith, L. J., Sumino, K., ... Ackerman, S. J. (2017). Race is associated with differences in airway inflammation in patients with asthma. Journal of Allergy and Clinical Immunology, 140(1), 257-265.e11. https://doi.org/10.1016/j.jaci.2016.10.024

Nyenhuis, Sharmilee M. ; Krishnan, Jerry A. ; Berry, Alalia ; Calhoun, William J. ; Chinchilli, Vernon M. ; Engle, Linda ; Grossman, Nicole ; Holguin, Fernando ; Israel, Elliot ; Kittles, Rick A. ; Kraft, Monica ; Lazarus, Stephen C. ; Lehman, Erik B. ; Mauger, David T. ; Moy, James N. ; Peters, Stephen P. ; Phipatanakul, Wanda ; Smith, Lewis J. ; Sumino, Kaharu ; Szefler, Stanley J. ; Wechsler, Michael E. ; Wenzel, Sally ; White, Steven R. ; Ackerman, Steven J. / Race is associated with differences in airway inflammation in patients with asthma. In: Journal of Allergy and Clinical Immunology. 2017 ; Vol. 140, No. 1. pp. 257-265.e11.

@article{89ce261061f148b59dd2b66869ce6654,

title = "Race is associated with differences in airway inflammation in patients with asthma",

abstract = "Background African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. Objective We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS−, respectively). Methods We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute–sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. Results Among 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P <.01), greater total IgE levels (197 vs 120 IU/mL, P <.01), and a greater proportion with uncontrolled asthma (43% vs 28%, P <.01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS− group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P =.28; ICS− group: 39% vs 35%, P =.65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P =.046) but not in the ICS− group (P =.984). Conclusion African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.",

keywords = "African American, Asthma, airway inflammation, body mass index, clinical trial, corticosteroid, eosinophil, induced sputum, race",

author = "Nyenhuis, {Sharmilee M.} and Krishnan, {Jerry A.} and Alalia Berry and Calhoun, {William J.} and Chinchilli, {Vernon M.} and Linda Engle and Nicole Grossman and Fernando Holguin and Elliot Israel and Kittles, {Rick A.} and Monica Kraft and Lazarus, {Stephen C.} and Lehman, {Erik B.} and Mauger, {David T.} and Moy, {James N.} and Peters, {Stephen P.} and Wanda Phipatanakul and Smith, {Lewis J.} and Kaharu Sumino and Szefler, {Stanley J.} and Wechsler, {Michael E.} and Sally Wenzel and White, {Steven R.} and Ackerman, {Steven J.}",

note = "Funding Information: Supported by grant U10HL098096 from the National Institutes of Health/National Heart, Lung, and Blood Institute Chicago Metropolitan AsthmaNet Consortium (CMAC) and U10 HL074225, U10 HLA074227, U10 HLA074231, U10 HLA074204, U10 HLA074212, U10 HLA074073, U10 HLA074206, U10 HLA074208, U10 HLA074218, and R21 HL118588-01 (to S.J.A.). Also supported by the American Academy of Allergy, Asthma, & Immunology/Association of Specialty Professors T. Franklin Williams Scholar (to S.M.N.), the University of Illinois at Chicago (UIC) Center for Clinical and Translational Science (CCTS), award nos. KL2RR029878 (to S.M.N.) and UL1TR000050 (to J.A.K.) from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publisher Copyright: {\textcopyright} 2016",

year = "2017",

month = jul,

doi = "10.1016/j.jaci.2016.10.024",

language = "English (US)",

volume = "140",

pages = "257--265.e11",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

publisher = "Mosby Inc.",

number = "1",

}

Nyenhuis, SM, Krishnan, JA, Berry, A, Calhoun, WJ, Chinchilli, VM, Engle, L, Grossman, N, Holguin, F, Israel, E, Kittles, RA, Kraft, M, Lazarus, SC, Lehman, EB, Mauger, DT, Moy, JN, Peters, SP, Phipatanakul, W, Smith, LJ, Sumino, K, Szefler, SJ, Wechsler, ME, Wenzel, S, White, SR & Ackerman, SJ 2017, 'Race is associated with differences in airway inflammation in patients with asthma', Journal of Allergy and Clinical Immunology, vol. 140, no. 1, pp. 257-265.e11. https://doi.org/10.1016/j.jaci.2016.10.024

Race is associated with differences in airway inflammation in patients with asthma. / Nyenhuis, Sharmilee M.; Krishnan, Jerry A.; Berry, Alalia; Calhoun, William J.; Chinchilli, Vernon M.; Engle, Linda; Grossman, Nicole; Holguin, Fernando; Israel, Elliot; Kittles, Rick A.; Kraft, Monica; Lazarus, Stephen C.; Lehman, Erik B.; Mauger, David T.; Moy, James N.; Peters, Stephen P.; Phipatanakul, Wanda; Smith, Lewis J.; Sumino, Kaharu; Szefler, Stanley J.; Wechsler, Michael E.; Wenzel, Sally; White, Steven R.; Ackerman, Steven J.

In: Journal of Allergy and Clinical Immunology, Vol. 140, No. 1, 07.2017, p. 257-265.e11.

Research output: Contribution to journal › Article › peer-review

TY - JOUR

T1 - Race is associated with differences in airway inflammation in patients with asthma

AU - Nyenhuis, Sharmilee M.

AU - Krishnan, Jerry A.

AU - Berry, Alalia

AU - Calhoun, William J.

AU - Chinchilli, Vernon M.

AU - Engle, Linda

AU - Grossman, Nicole

AU - Holguin, Fernando

AU - Israel, Elliot

AU - Kittles, Rick A.

AU - Kraft, Monica

AU - Lazarus, Stephen C.

AU - Lehman, Erik B.

AU - Mauger, David T.

AU - Moy, James N.

AU - Peters, Stephen P.

AU - Phipatanakul, Wanda

AU - Smith, Lewis J.

AU - Sumino, Kaharu

AU - Szefler, Stanley J.

AU - Wechsler, Michael E.

AU - Wenzel, Sally

AU - White, Steven R.

AU - Ackerman, Steven J.

N1 - Funding Information: Supported by grant U10HL098096 from the National Institutes of Health/National Heart, Lung, and Blood Institute Chicago Metropolitan AsthmaNet Consortium (CMAC) and U10 HL074225, U10 HLA074227, U10 HLA074231, U10 HLA074204, U10 HLA074212, U10 HLA074073, U10 HLA074206, U10 HLA074208, U10 HLA074218, and R21 HL118588-01 (to S.J.A.). Also supported by the American Academy of Allergy, Asthma, & Immunology/Association of Specialty Professors T. Franklin Williams Scholar (to S.M.N.), the University of Illinois at Chicago (UIC) Center for Clinical and Translational Science (CCTS), award nos. KL2RR029878 (to S.M.N.) and UL1TR000050 (to J.A.K.) from the National Center for Advancing Translational Sciences. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Publisher Copyright: © 2016

PY - 2017/7

Y1 - 2017/7

N2 - Background African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. Objective We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS−, respectively). Methods We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute–sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. Results Among 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P <.01), greater total IgE levels (197 vs 120 IU/mL, P <.01), and a greater proportion with uncontrolled asthma (43% vs 28%, P <.01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS− group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P =.28; ICS− group: 39% vs 35%, P =.65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P =.046) but not in the ICS− group (P =.984). Conclusion African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.

AB - Background African American subjects have a greater burden from asthma compared with white subjects. Whether the pattern of airway inflammation differs between African American and white subjects is unclear. Objective We sought to compare sputum airway inflammatory phenotypes of African American and white subjects treated or not with inhaled corticosteroids (ICSs; ICS+ and ICS−, respectively). Methods We performed a secondary analysis of self-identified African American and white subjects with asthma enrolled in clinical trials conducted by the National Heart, Lung, and Blood Institute–sponsored Asthma Clinical Research Network and AsthmaNet. Demographics, clinical characteristics, and sputum cytology after sputum induction were examined. We used a sputum eosinophil 2% cut point to define subjects with either an eosinophilic (≥2%) or noneosinophilic (<2%) inflammatory phenotype. Results Among 1018 participants, African American subjects (n = 264) had a lower FEV1 percent predicted (80% vs 85%, P <.01), greater total IgE levels (197 vs 120 IU/mL, P <.01), and a greater proportion with uncontrolled asthma (43% vs 28%, P <.01) compared with white subjects (n = 754). There were 922 subjects in the ICS+ group (248 African American and 674 white subjects) and 298 subjects in the ICS− group (49 African American and 249 white subjects). Eosinophilic airway inflammation was not significantly different between African American and white subjects in either group (percentage with eosinophilic phenotype: ICS+ group: 19% vs 16%, P =.28; ICS− group: 39% vs 35%, P =.65; respectively). However, when adjusted for confounding factors, African American subjects were more likely to exhibit eosinophilic airway inflammation than white subjects in the ICS+ group (odds ratio, 1.58; 95% CI, 1.01-2.48; P =.046) but not in the ICS− group (P =.984). Conclusion African American subjects exhibit greater eosinophilic airway inflammation, which might explain the greater asthma burden in this population.

KW - African American

KW - Asthma

KW - airway inflammation

KW - body mass index

KW - clinical trial

KW - corticosteroid

KW - eosinophil

KW - induced sputum

KW - race

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DO - 10.1016/j.jaci.2016.10.024

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SP - 257-265.e11

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

SN - 0091-6749

IS - 1

ER -

Race is associated with differences in airway inflammation in patients with asthma

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