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Asthma Treatment Response Modified by PM 2.5 , NO 2 , and O 3 Among African American Children: A Reanalysis of the AsthmaNet's BARD Trial
Journal article   Open access   Peer reviewed

Asthma Treatment Response Modified by PM 2.5 , NO 2 , and O 3 Among African American Children: A Reanalysis of the AsthmaNet's BARD Trial

Lizbeth F Gómez, Ellen Kinnee, Michael T Young, Joel D Kaufman, Anne M Fitzpatrick, Sharmilee M Nyenhuis, Julian Solway, Steven R White, Edward T Naureckas, Wanda Phipatanakul, …
Journal of allergy and clinical immunology, v 156(2), pp 330-338
15 Apr 2025
DOI: https://doi.org/10.1016/j.jaci.2025.04.009
PMID: 40245951
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
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https://doi.org/10.1016/j.jaci.2025.04.009View
Published, Version of Record (VoR)Open Access via Drexel Libraries Read and Publish Program 2025CC BY V4.0,  Open

Abstract

RCT ICS/LABA Air Pollution Asthma Environmental Health
Asthma morbidity significantly affects children of all racial backgrounds; however, African American children experience a greater disease burden than children from other racial groups. Despite the known influence of air pollution on asthma outcomes, its role in the efficacy of asthma treatments remains underexplored. To examine how exposure to particulate matter (PM ), nitrogen dioxide (NO ), and ozone (O ) influenced treatment outcomes in the NIH AsthmaNet Best African American Response to Asthma Drugs (BARD) trial. The BARD trial randomized 224 African American children to four asthma treatments consisting of inhaled corticosteroids (ICS) and long-acting beta antagonists (LABA) administered in a randomized crossover fashion. Treatment efficacy was assessed by the frequency of asthma exacerbations, percent predicted FEV (%PFEV ), and annualized asthma control days. Residential exposures to PM , NO and O were estimated using a validated spatiotemporal model. Mixed effects models were used to evaluate the interaction between pollution exposure and treatment efficacy, adjusting for age, household triggers and trial site. PM , NO and O exposures ranged substantially across participants: from 2.28 - 15.3 μg/m , 2.34 - 63.7 ppm, and 2.57 - 23.7 ppb, respectively. NO and PM exposures were not associated with increased exacerbations post-treatment (p for interaction = 0.15 and 0.08, respectively). However, NO exposure significantly modified the effect of high-dose ICS+LABA therapy on lung function. Children with below median NO exposures while on ICS + LABA had a reduction of 5.86 (1.16, 10.56) in %PFEV compared to those with above-median NO exposures. Residential high NO exposure may significantly attenuate the efficacy of ICS+LABA therapy on lung function in African American children. These findings suggest the need to consider environmental factors in clinical trials and asthma management strategies.

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#3 Good Health and Well-Being
#11 Sustainable Cities and Communities

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Collaboration types
Domestic collaboration
Web of Science research areas
Allergy
Immunology
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