How does race/ethnicity influence pharmacological response to asthma therapies?

ABSTRACT

Introduction: Our understanding of whether and/or how ethnicity influences pharmacological response to asthma therapies is still very scarce. A possible explanation for the increased asthma treatment failures observed in ethnic and racial minorities receiving asthma therapies is that some of these groups may have a pharmacogenomic predisposition to either nonresponse or to adverse response with a specific class of drugs. However, the effects of ethnicity on pharmacological response to asthma therapies are also, and mainly, determined by socioeconomic and environmental factors to a varying extent, depending on the ethnic groups.

Areas covered: Genetic, socioeconomic and environmental factors that can affect the pharmacotherapeutic responses to asthma medications and their link(s) to race/ethnicity have been examined and critically discussed.

Expert opinion: Differences in genetic ancestry are definitely non-modifiable factors, but socioeconomic and environmental disadvantages are all factors that can be modified. It is likely that improved outcomes may be achieved when tailored and multifaceted approaches that include home, school, and clinician-based interventions are implemented. Consequently, it is critical to determine if a clinical intervention programme combined with implementation strategies that attempt to reduce inequalities can reduce asthma disparities, including the influence of ethnicity and race on pharmacological response to asthma therapies.

KEYWORDS:

• Asthma
• environmental factors
• ethnicity
• genetic factors
• pharmacotherapy
• race
• socioeconomic factors

Article highlights

• The available evidence suggests that compared to White counterparts, African Americans and Hispanics/Latinos suffering from asthma are less responsive to asthma medications when prescribed as part of the general asthma guidelines.

• Ethnic differences in drug response may be due to the interaction of genetic differences and the environmental effects on individuals, as well as the pathogenesis of the disease itself.

• The genetic differences between ethnic groups result from differences in the distribution of polymorphisms that are related to the enzymes responsible for drug metabolism. Even a single difference in a nucleotide of a candidate gene can have a profound impact on pharmacological response to asthma therapeutics. However, race is a crude proxy to genetic ancestry and falls short of explaining the variation in response to medication.

• Worse outcomes in asthma outcomes have been attributed to a varying extent, depending on the ethnic groups, to multiple factors such as socioeconomic factors (namely income, education), racial/ethnic genetic variants, environmental allergen/pollutant exposures, psychosocial stressors (neighborhood violence/safety), behavioral risk factors (smoking, obesity), poor medication adherence, and/or lack of access (to medicines, quality evidence-based care).

• Differences in genetic ancestry that may influence responses to asthma medications are definitely non-modifiable factors, but poor health, disease risk factors, medication non-adherence, health literacy and limited access to health care due to social, economic and environmental disadvantages are all modifiable factors.

• Likely, improved outcomes may be achieved when tailored and multifaceted approaches that include home, school, and clinician-based interventions are implemented.

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Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties. Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper is not funded.