Nearly 28 million adults and children live with asthma in the U.S., making it one of the most common chronic conditions in the country. But asthma rates are higher in some populations than others.
“We know based on multiple studies that there are disparities that exist within the asthmatic population, specifically the Black community,” says Lauren Fill, DO, an allergist/immunologist at Allergy/Immunology Associates in Cleveland. “They’re two to five times more likely than other groups to be hospitalized due to asthma, and have a higher associated mortality rate as well.”
The burden of asthma is also heaviest on Indigenous and Puerto Rican populations.
The reasons for this imbalance are complex, says Lynne Bosma, health equity and outreach program manager with the Asthma and Allergy Foundation of America.
“Asthma can be affected by genetics or ancestry,” she says, ”and interactions between genetic factors and environmental triggers such as air pollution – which (these communities) are more likely to be burdened by – may also impact asthma.”
A Large-Scale Approach
Treating asthma on a personal level involves working with your doctor, taking medications, and adopting specific lifestyle changes to help manage symptoms. But addressing the community burden of asthma requires a step back to troubleshoot the larger issues that are involved, research shows.
“Many actions are needed to improve racial and ethnic asthma disparities, including expanded health insurance coverage, better access to asthma specialists and appropriate medications, increased inclusion and diversity in the medical community, and environmental justice solutions to reduce the unequal burden of exposure to asthma risk factors,” says Bosma.
Socioeconomic factors are a key piece of the puzzle. Studies show living in inner-city environments and having a lower income increase your risk of getting asthma. That’s partly due to air pollution, substandard housing, and exposure to pests, mold, and other allergens. Lack of health insurance coverage and access to health care also play a major role.
“This all plays into why these populations don’t seek care as compared to someone else that may have more resources,” says Fill. “For non-English speakers, the language difference between them and their provider can be a huge barrier to care, too.”
Local and National Asthma Initiatives
In response to these things that worsen asthma outcomes, many community resources have cropped up in the U.S., from the regional level all the way up to the national level.
The CDC’s National Asthma Control Program is the main source of funding for state, tribal, local, and territorial agencies to establish and maintain asthma public health programs. The CDC’s EXHALE strategy stands for:
- Education on asthma self-management
- "X-tinguishing" smoking and exposure to secondhand smoke
- Home visits for trigger reduction and asthma self-management education
- Achievement of guidelines-based medical management
- Linkages and coordination of care
- Environmental policies, or best practices to reduce indoor and outdoor asthma triggers
Two decades ago, Boston Children's Hospital’s Community Asthma Initiative developed a system to find people who weren’t getting adequate asthma care and to deliver care where needed with nurses and case managers. The initiative also works with partners to address asthma health disparities through policy changes at the local and state levels.
The results of the study linked to this program “were pretty staggering,” says Fill. “Patients had improved significantly as a result of their initiative and as a result of what they did to intervene in their care. Several other national programs have since been based off of that successful model.”
The Allergy and Asthma Foundation of America's Health Equity Advancement and Leadership (HEAL) program is an example of a local approach. HEAL is a multiyear project that aims to build and support community-based interventions to address asthma inequities.
The foundation partners with local organizations that educate people on how to manage asthma, help them connect with asthma specialists, provide home visits to help them reduce asthma triggers, and more. The programs often use health workers from the communities they serve, which helps to build trust.
“This model of care has been proven to achieve better health in communities with an asthma burden,” says Bosma. “In 2024, HEAL served over 250 people who are now managing their asthma better in communities like Detroit, L.A., Chicago, N.Y., St. Louis, and more.”
After six months in the program, says Bosma, people in HEAL report better asthma control as well as more confidence in managing their asthma and in identifying and reducing triggers. They have fewer emergency room visits, better use of quick-relief asthma medicine, and fewer daytime and nighttime asthma symptoms.
Addressing Asthma Early
One key to a community-based approach to asthma management and prevention is educating families and increasing asthma awareness from the time a child is born.
“About 50% of people with asthma in childhood go on to continue to have adult asthma,” says Fill. “If we can identify these kids at a younger age, we can prevent that lifelong disease progression” along with health care costs, deaths, and so on, she says.
The American Lung Association’s Open Airways for Schools has helped establish asthma education programs for students and staff in more than 40,000 schools in the U.S.
Studies have shown that kids who take part in Open Airways for School:
- Feel more confident about controlling their asthma
- Are more able to influence their parents’ decisions about managing their asthma
- Have fewer, and less serious, asthma attacks
- Do better in school
Where Can I Find a Community Program?
To find community asthma programs in your area, check with:
- Your doctor
- A school nurse
- Your local health department
- The websites of groups like the Asthma Community Network, Allergy and Asthma Foundation of America, or American Lung Association
Show Sources
Photo Credit: Klaus Vedfelt/Getty Images
SOURCES:
Lauren Fill, DO, allergist/immunologist, Allergy/Immunology Associates, Cleveland.
Lynne Bosma, health equity and outreach program manager, Asthma and Allergy Foundation of America
American Lung Association: “Asthma Trends Brief,” “Open Airways for Schools.”
Office of Minority Health: “Asthma and Hispanic Americans.”
Current Opinion in Allergy and Clinical Immunology: “Environment and the Development of Severe Asthma in Inner City Population.”
Asthma and Allergy Foundation of America: “Health Equity.”
Environmental Protection Agency: “Where in my community can I get help for managing asthma?”
