Abstract
Background and objective: There are significant health disparities between Maori and non-Maori with asthma, a pattern seen between other ethnic populations. This study investigates outcomes for Maori in a randomized controlled trial (RCT) of combination budesonide/formoterol inhaler therapy in asthma.
Methods: This 24-week multicentre RCT recruited 303 adult asthma patients, 44 of whom were Maori. Participants were randomized to the single combination budesonide/formoterol inhaler as maintenance and reliever therapy ('SMART') regimen or 'standard' regimen (combination budesonide/formoterol inhaler for maintenance and salbutamol as reliever). Outcomes included patterns of beta-agonist inhaler use including 'high use' of reliever therapy (>8 actuations of budesonide/formoterol in excess of four maintenance doses per day for SMART and >16 actuations per day of salbutamol for standard). Differences in outcomes for Maori versus non-Maori were assessed using an interaction term between ethnicity and treatment.
Results: With adjustment for ethnicity, the SMART group had fewer days of high use (relative rate (RR) 0.57 (95% confidence interval (CI): 0.38-0.85)), days of high use without medical review within 48 h (RR 0.49 (95% CI: 0.32-0.75)) and severe exacerbations (RR 0.54 (95% CI: 0.36-0.81)) compared with standard. The magnitude of the benefit from the SMART regimen was similar in Maori and non-Maori. Regardless of treatment regimen, Maori demonstrated more days of high use, high use without medical review and underuse of maintenance therapy.
Conclusions: The SMART regimen has a favourable risk/benefit profile in Maori. Days of high use, days of high use without medical review and underuse of maintenance treatment were greater in Maori, regardless of treatment regimen.