Reducing disparities in asthma prevalence in Black and Latino people

A new study finds that an easy-to-use, patient-centered approach to managing moderate to severe asthma resulted in improved outcomes for Black and Latino adults.

According to an article in the New England Journal of Medicine, Black and Latino patients bear a disproportionate burden of asthma. Attempts to reduce this disparity have been mostly unsuccessful, and guideline recommendations have not been based on studies of Black and Latino patients. However, the use of an inhaled glucocorticoid, short-acting bronchodilator, and one-time instruction on its use for symptom relief when added to usual physician care, led to a lower rate of severe asthma exacerbations in Black and Latino patients, according to findings of the PREPARE study.

According to the authors, after adjustment for prevalence, the rates of asthma-related emergency department visits and hospitalizations are higher among Black and Latino persons than among white persons, and mortality from asthma is twice as high among Black and Latino persons as among white persons. The authors include Geoffrey Chupp, MD, professor (pulmonary) in the section of Pulmonary, Critical Care & Sleep Medicine at Yale School of Medicine (Yale-PCCSM), and director of the Yale Center for Asthma and Airways Disease.

"Efforts to improve asthma management and reduce this burden have been labor-intensive, expensive, and variably effective," the authors said.

In an accompanying editorial comment, "Breaking the Skin Color Barriers for Asthma Medications—It's not Black, Brown or White," Tyra Bryant-Stephens, MD, from the Community Asthma Prevention Program, Center for Health Equity, Children's Hospital of Philadelphia, and the Perelman School of Medicine, University of Pennsylvania, emphasized that "although asthma disproportionately affects Black and Latinx patients, they are underrepresented in studies of therapy, which makes it difficult to determine whether the results may be applied to them." However, she said that the study's recruitment of Black and Latino participants underscored the contributions of the trial to the field.

Bryant-Stephens also said that since "race is not a biologic but a social construct, health disparities among persons with asthma are not a result of the color of the patient's skin but rather the result of the structural and systemic racist practices that render these patients at risk for poor outcomes and that must be addressed when studying these populations."

Chupp suggests that rather than being race-specific, studies should be designed to require that all relevant racial groups be included. "The risk is that some group will always be left out," he said.

More information:
Elliot Israel et al, Reliever-Triggered Inhaled Glucocorticoid in Black and Latinx Adults with Asthma, New England Journal of Medicine (2022). DOI: 10.1056/NEJMoa2118813

Tyra Bryant-Stephens, Breaking the Skin Color Barriers for Asthma Medications—It's Not Black, Brown, or White, New England Journal of Medicine (2022). DOI: 10.1056/NEJMe2201666

Provided by Yale University