Adding Anticholinergic Therapy to Inhaled Corticosteroids in Black Patients

National asthma guidelines recommend long-acting β-agonists (LABAs) for patients whose asthma is not controlled by low-dose inhaled corticosteroids (ICS; J Allergy Clin Immunol 2007; 120:5 Suppl:S94); however, LABAs might be associated with risk for severe asthma exacerbations. In SMART, black patients who used salmeterol were more likely to suffer asthma-related deaths than were white salmeterol recipients (NEJM JW Gen Med Mar 1 2006 and Chest 2006; 129:15); black patients have a higher incidence of β₂-adrenergic–receptor polymorphisms that are associated with impaired response to β-agonists.

Now, in an open-label U.S. primary care study, 1070 black patients with moderate-to-severe asthma were randomized to once-daily tiotropium (a long-act…