Juan Carlos Cardet, MD: PARTICS Reduces Asthma Disparities in Black and Latino Communities

New data presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022 found that a patient-centered, one-time instruction in Patient-Activated Reliever-Trigger Inhaled Corticosteroid Strategy (PARTICS) resulted in minimal inhaled corticosteroid use, reduced asthma exacerbations, and improved asthma control and quality of life in African American and Hispanic/Latinx patients with poorly controlled asthma.

In an interview with HCPLive, Juan Carlos Cardet, MD, University of Southern Florida, spoke of how the data from the recent PREPARE study could inform asthma care for disproportionately affected communities.

“That disparity has has existed for decades, right, and efforts have been made,” Cardet said. “But it's just consistently the case that both Black and Latino patients have more asthma morbidity in the form of asthma attacks per year, or ER visits or hospitalizations. Just the death rates from asthma are higher for both these populations.”

Cardet noted the overuse of rescue therapy in the absence of controller therapy in these populations, as well as efforts to send nurses to patient’s homes to communicate messages of asthma management. However, results have been negative, as these practices are difficult to implement due to staffing issues and various expenses.

In an effort to combat asthma morbidity in Black and Latinx communities, Cardet and colleagues conducted the PREPARE study, a patient-centered outcomes research institute funded trial that tested PARTICS in 1201 Black and Latinx patients 19-75 years old with poorly controlled asthma.

The study included patient partners and advocates who understood the disease and how it affected these communities, which Cardet considered to be a unique aspect of the study. Advocates would help investigators with communicating study concepts to patients and vetted the 15 monthly questionnaires that followed the 1 instructional visit.

“I think that helped out in the end with the high survey completion rates,” Cardet said. “In these 12, 101 participants after 15 months, we had 92%, survey completion rates. Dropouts were, minimal from the study, and after all those months, a 92% survey completion rate is very high.”

The study found that PARTICS, in addition to the usual care these patients received, reduced severe asthma exacerbations by 15.4% (p50.048) which corresponded to a reduction of 13 exacerbations/100 patient-years.

Additionally, ACT scores improved by >_3 points from baseline during 11.8% more study months for patients assigned to PARTICS+UC versus UC (p50.006), and Asthma Symptom Utility Index scores improved by 0.12 versus 0.08 points (p< 0.0001).

“What we did in our trial was: keep doing what your doctor tells you to do, however complex your controller therapy regimen is and on top of that, whenever you puff yourself with rescue therapy, puff yourself also with this ICS inhaler that I'm going to give to you for the duration of the trial,” Cardet said. “So, it doesn't replace anything, it just adds on to it.”

Cardet noted that the strategy from the PREPARE study was similar to the Single Maintenance and Reliever Therapy (SMART) strategy in previous studies. The SMART strategy utilized 1 inhaler with inhaled corticosteroids and formoterol, a long-acting onset beta agonist.

However, unlike the SMART strategy, PARTICS does not require patients to change their controller therapy regimen, and Cardet is hopeful that data from the PREPARE study will help implement this strategy in clinics across the country.

“Our goal is to bring it to the clinic,” he said. “Is it a solution to the disparity to the healthcare disparity between Blacks and Latinos and Whites and other racial ethnic groups? I don't think so. There's so many layers to that, but whatever it is that we can do to chip away at that disparity, we'll take it.”