BELT Study Does Not Answer the Question About the Best Asthma Treatment for Black Patients

Q: How will the BELT trial impact treatment of black adults with asthma?

A: The jury is still out.

Despite fears about long acting beta-agonists (LABAs), the Blacks and Exacerbations on LABA vs. Tiotropium (BELT) trial results do not support the superiority of LABA + ICS compared to tiotropium + ICS for black asthma patients.

What we do know

Increasing evidence supports the therapeutic use of anticholinergic agents for asthma, particularly for patients with airway obstruction or signs of higher cholinergic tone. These study findings do not provide enough evidence to overturn the National Asthma Education and Prevention Program’s (NAEPP) Third Expert Panel Report guidelines for prescribing ICS + LABA for this patient population.

There is a black box warning on LABAs, but there are no obvious treatment benefits to LABA vs. anti-cholinergics in this study. Currently anticholinergic agents are not included in the step approach to the NAEPP’s asthma treatment protocols. However, this study lends more support that anticholinergics may be a considered as an additional therapeutic option for treating asthma.

More study is needed

How this study will impact the treatment of black patients with asthma is unclear since there was no superiority of LABA + ICS vs. tiotropium + ICS in primary or secondary outcomes. Further studies, including placebo-controlled studies and improved objective testing of severity of asthma when including patients in the study, are needed.

Sandra Hong, MD

Sandra Hong, MD, in the Cleveland Clinic Department of Pulmonary, Allergy and Critical Care Medicine, can be reached at 440.878.2500 or hongs3@ccf.org.

David M. Lang, MD

David M. Lang, MD, Chair of the Department of Allergy and Clinical Immunology, can be reached at 216.445.5810 or langd@ccf.org.