By Jami Koziel, RRT, CPFT
Pulmonary Services, Blanchard Valley Health System

Asthma is a heterogeneous respiratory disease–meaning it presents in many different ways–that affects an estimated 25 million Americans, with six million being children. The financial cost of asthma exceeds $81 billion every year and despite all the resources invested, asthma is responsible for over 3,500 deaths annually in the United States. The prevalence of asthma is proven to be higher among individuals of low socioeconomic status than among those with higher socioeconomic status. 

Generally, there has been a lack of priority in the effects and differences in asthma prevalence among populations as well as the response to therapies among racial and ethnic minorities. To illustrate, African American patients respond differently to corticosteroids in contrast with White patients. One study suggests Hispanic and non-Hispanic White children exhibit better responses to increasing therapy with Long-Acting Beta Agonist (LABA), rather than higher doses of Inhaled Corticosteroids (ICS), whereas African American children were less likely to respond to adding leukotriene receptor antagonists, and more likely to respond to increasing dosing of ICS.

Genetic variants in the receptors for these pharmaceutical agents may be the potential explanation for these response variations according to racial background. More recently, the therapeutic approach to asthmatic patients has been broadened by better phenotypic characterization and the recognition of particular inflammatory pathways that can be targeted through novel medications produced in living organisms. These medications are commonly known as biologicals. Though biologicals are proven to significantly improve outcomes for patients, racial groups and socioeconomic status still play a factor in access to specialty care in addition to income ranking. These barriers still fully need to be identified and addressed. 

Diet is also a major factor in asthma symptoms. Certain diet structures can cause systemic inflammation, oxidative stress, and the microbiome all have notable effects on asthma. In the United States, 12 percent of households are limited or unable to obtain adequate food, notably being highly prevalent among racial and ethnic minority groups. Moreover, racial and ethnic minority populations are more likely to live in urban areas which have limited access to fresh quality foods at affordable prices. To help governmental efforts such as the Supplemental Nutrition Assistance Program, also known as “SNAP,” have shown significant benefits in reducing the number of emergency room visits due to asthma and could contribute to eliminating the “eat or breathe” challenge that many low-income families face and overall health care.

Air pollution is another significant culprit in asthma cases. An estimated four million cases of new pediatric asthma are attributed to a single pollutant: nitrogen dioxide (NO2), which is a gas commonly associated with traffic pollution. Despite progress being made, three decades later, air pollutants affect neighborhoods predominantly populated by minorities far greater than White neighborhoods. Asthma prevalence is also associated with poor housing, relating to a higher instance of emergency room visits. Overall health outcomes are reliant on housing quality, affordability and stability.

In conclusion, efforts to recruit and include populations of minority origin need to be made, unfortunately, clinical trials thus far do not report the distribution of race and ethnicity in their participants. In the United States, prevalence rates are overwhelmingly disproportionate in racial and ethnic minorities. To aid in conditions causing asthma in these existing disparities, housing and environmental policies must be set in place, as well as continued efforts in identifying contributing factors. With persistence, these systematic efforts will assist in diminishing asthma-related health disparities.