How does race and ethnicity effect the precision treatment of asthma?

Racial bias in recruitment to clinical trials on paediatric asthma

Asthma is now the commonest chronic disease of childhood, but not all children with asthma receive equivalent standards of medical care which influences their clinical outcomes. In this paper we sought to determine the proportion of participants in registered clinical trials relating to paediatric or adolescent asthma over the last decade that were from white and non-white backgrounds. We searched the ClinicalTrials.gov database for all completed interventional studies between the dates 1st January 2011 and 1st January 2021 that were on the topic of 'asthma', and included participants below 18 years of age. Of the 500 studies returned, 208 had results available on the ClinicalTrials.gov website. In total, of the 112,327 patients studied, almost 69 % (77,333) of the patients were described as White or Caucasian, and fewer than 13 % (14,189) were described as Black, African, or African-American. Overall, approximately 30 % of study participants - some 34,207 children - were from non-white backgrounds. To redress this imbalance, researchers designing clinical trials must ensure that their study populations are as representative of the target population for the intervention as possible.

Analysis of the polymorphic variants of ADRB2 gene association with the β2-agonists response in patients with a rare theratype of asthma

Standard asthma therapy includes prescription of β2-agonists. Changes in the functional activity of β2-adrenergic receptor are associated with ADRB2 genepolymorphism and related to the low therapeutic response to β2-agonists. Identification of carriers of the clinically significant gene variants will help to avoidineffective treatment and prescribe an alternative therapy. This study aimed to assess clinical significance of the ADRB2 gene polymorphisms (Arg16Gly andGln27Glu) associated with the therapeutic response to β2-agonists in the group of asthma patients. We subjected a small group of adult nonsmoking patients(n = 21) with moderate asthma (III–IV stage of GINA) to clinical and genetic examination. The group included patients with the new theratype, those that poorlyrespond to β2-adrenergic drugs but significantly to M-cholinergic agonists. The first group included patients responding well to both salbutamol and ipratropiumbromide. The second group was comprised of the patients for whom salbutamol was not effective but who tested positive for response to ipratropium bromide. Theanalysis of distribution of polymorphic variants of Arg16Gly and Gln27Glu revealed no significant relationship between alleles and genotypes and the efficacy of β2-agonists(0.52 for the rs1042713 variant, p = 1.0; 1.0 for the rs1042714 variant, p = 0.74, respectively). The genotype of patients that did not respond to salbutamol waseither Arg16Gly or Gly16Gly. Further studies are needed that would involve a larger number of patients and an expanded list of the tested polymorphic variants.