Black, Hispanic patients with asthma experience more exacerbations, hospitalizations
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Key takeaways:
- Black and Hispanic respondents with asthma exacerbations were less likely to seek acute care based on symptoms.
- These groups had more exacerbations than white respondents and were more likely to be hospitalized.
SAN DIEGO — Black and Hispanic asthma patients reported a higher incidence of asthma exacerbations than white patients, according to a poster shown at the American Thoracic Society International Conference.
“Black and Hispanic respondents who experienced asthma exacerbations (AEs) were less likely to report experiencing cough and wheezing and less likely to use their quick-relief inhaler before seeking acute care,” De De Gardner, DrPH, RRT, RRT-NPS, FAARC, FCCP, chief research officer with Allergy & Asthma Network (AAN) and lead author of the study, told Healio.
“This makes us wonder if patients are making choices to reserve their home medication and seek care to attain care for their AEs. We also recognize there is a large need for asthma self-management education to be culturally and linguistically appropriate,” she continued.
The survey included 504 adults (72% women; 79% white; 88% non-Hispanic) recruited from a research panel that participated in an online survey between July 25 and Aug. 4, 2023. All had experienced at least one asthma exacerbation that required acute care during the past 12 months.
The survey explored whether race-specific differences exist in instances of asthma exacerbations. It asked about incidence of AEs, whether a hospitalization took place following it, where the site of care was (home, doctor’s office, urgent care, emergency room, or hospital), and what the symptoms (wheezing, coughing) were prior to seeking care as well as what actions were taken post-care.
Across all measures, the highest percentages were seen among Black respondents.
For example, 51% of white patients, 54% of Black patients and 40% of Hispanic patients had experienced one or more AEs in the previous 24 months.
Also, 55% of white patients, 78% of Black patients and 69% of Hispanic patients utilized acute care for their most recent asthma attack.
Hispanic respondents reported the lowest incidence of AEs and the second highest rate of acute care use and hospitalizations.
The responses to the site of care varied among groups. Two-thirds of white respondents self-managed at home (44%) or visited a doctor’s office (19%). The distribution of acute care settings and non-acute care settings were equal for Black and Hispanic respondents. However, Black (8%) and Hispanic (7%) patients showed to be about twice as likely to be hospitalized as white patients (4%).
The distribution of responses about symptoms prior to seeking care for white respondents was 35% for wheezing and 34% for coughing. Black patients had 26% and 33%, and Hispanics had 38% and 29%.
Researchers noted the three most common behaviors for white and Hispanic respondents before seeking acute care included using a quick-relief inhaler, nebulizer, and meditation and focused breathing, with Hispanic individuals showing a 9% lower use of quick-relief inhalers.
Black respondents were 1.4 times more likely to use a nebulizer and just as likely as Hispanic respondents to use an inhaler, and they also listed calling a physician in their top three behaviors. Both Black (62%) and Hispanic (63%) respondents were less likely than white respondents (81%) to seek acute care based on the severity of their AE.
Healio asked Gardner what health care providers can do in order to improve outcomes for Black and Hispanic patients.
“Make time for asthma self-management education that is culturally and linguistically meaningful to the patient and caregivers,” she said.
AAN’s Trusted Messengers outreach program partners with community organizations in underserved areas to provide screenings as well as educate and coach patients about asthma care.
“If an [health care provider] does not have an asthma self-management program, then refer the patient to the Trusted Messengers virtual asthma coaching program for free asthma self-management education,” Gardner said.
Gardner further explained that this includes a six-session asthma guideline-based education program with digital technology and follows the participant for 13 months.
“We need to recognize Black and Hispanic/Latino communities have a history of being under-resourced and have inadequate access to asthma specialists,” Gardner said. “This could be because of the redlining of communities and homes that are in industrial areas, have poor indoor and outdoor air quality, and lead to patients having high asthma morbidity and mortality.”
The implications through studies that show disparities among historically disadvantaged communities call attention to public policy, she continued.
“We need to support the Safe Step Act [to improve step therapy policies], increase access to medications, use race-neutral parameters when performing spirometry, and make research a health care choice instead of a last-ditch effort,” Gardner said.