Approaches to Step-Up Therapy in Black Patients with Asthma

For patients with uncontrolled asthma who take low-dose inhaled corticosteroids (ICS), guidelines call for adding a long-acting β-agonist (LABA) in adults. For children who are 5 years or younger, a medium-dose ICS is recommended and, for children who are 6 to 12 years old, either a medium-dose ICS or low-dose ICS plus a LABA is suggested. However, asthma trials that inform these guidelines were performed largely in white populations. Now, in a randomized crossover trial, researchers examined various step-up treatment regimens in self-identified black patients with uncontrolled asthma (280 children [age range, 5–11 years] and 294 adolescents and adults).

After a 2-week run-in period of ICS fluticasone (50 μg twice daily for children, and 100…