Blacks, Hispanics and Asians use asthma inhalers less than whites, UCLA-led research finds.
Photo Credit: Bob Williams
Scientific Frontline: Extended "At a Glance" Summary: Racial Disparities in Asthma Inhaler Use
The Core Concept: A recent UCLA-led study reveals that Black, Hispanic, and Asian adults in the US use guideline-recommended daily asthma controller inhalers significantly less frequently than white adults, despite overall increases in healthcare access.
Key Distinction/Mechanism: The study highlights a treatment and utilization gap driven by sociodemographic and healthcare access factors, rather than a difference in asthma prevalence. It distinguishes between the underutilization of preventative, long-acting controller medications among minority groups and the reliance on short-acting rescue inhalers, which typically indicates poorly controlled asthma.
Origin/History: Published in the peer-reviewed journal JAMA, the research pooled data from the Medical Expenditure Panel Survey from 2014 through 2023. This updated previous data from the late 1990s, demonstrating that treatment disparities persist even after the expansion of health insurance coverage through policies like the Affordable Care Act.
Major Frameworks/Components: The study analyzed the usage of four primary types of asthma medications:
- Inhaled Corticosteroids (ICS): Preventative medications used to reduce airway inflammation.
- Long-Acting Beta Agonists (LABA): Controller medications designed to keep airways open over the long term.
- Long-Acting Muscarinic Antagonist (LAMA): Medications that relax airway muscles to allow for unobstructed breathing.
- Short-Acting Beta-Agonists (SABA): Quick-relief or "rescue" inhalers used during acute asthma attacks.
Branch of Science: Pulmonology, Internal Medicine, Health Services Research, and Epidemiology.
Future Application: The findings provide a foundation for targeted public health interventions, policy adjustments to improve pharmacoequity, and further academic research into physician prescribing behaviors and how patients adapt to changing treatment guidelines.
Why It Matters: Addressing these disparities is critical for achieving health equity. Unequal access to specialty care and preventative medications leaves minority populations at a higher risk for uncontrolled asthma, reduced quality of life, and preventable medical emergencies.
Despite guidelines recommending daily controller inhalers as the best treatment for asthma, new UCLA-led research finds that Black, Hispanic, and Asian patients use them less than White patients, suggesting that socioeconomic factors and a lack of access to specialty care are at the root of this gap.
Asthma is a common condition that affects people of all races and ethnicities, and the medications available to patients can substantially improve their quality of life, said Dr. Utibe Essien, assistant professor of medicine in the Division of General Internal Medicine and Health Services Research at the David Geffen School of Medicine at UCLA, and the study’s senior author. However, no one had undertaken a thorough look at who has access to these medications in more than 15 years, he said.
The researchers on the new study, published in the peer-reviewed journal JAMA, looked at who was using appropriate, guideline-recommended inhalers for the condition in more recent years, when more people have been diagnosed with asthma—and the medications have become more expensive.
They found that significant gaps in usage remain, Essien said.
“This is a really important extension of the data from the late 1990s, given the fact that we have more access to care since the late 1990s and 2000s, and we have a lot more people with health insurance through policies like the Affordable Care Act, so we have more people engaged in medical care and still see these gaps in treatment,” he said.
The researchers pooled data from the Medical Expenditure Panel Survey for the years 2014 through 2023 for about 10,500 U.S. adults, representing over 1.1 million Americans 18 years of age and older who were being treated for asthma. Of these patients, 55% were White, 20% were Black, 16% were Hispanic, 3% were Asian, and the rest were of other or multiracial backgrounds.
They examined the use of inhaled corticosteroids (ICSs), which reduce airway inflammation; long-acting beta-agonists (LABAs), which keep airways open in the long term; long-acting muscarinic antagonists (LAMAs), which also relax airway muscles to allow for unobstructed breathing; and short-acting beta-agonists (SABAs), which provide quick relief when patients have an asthma attack.
Reliance on SABA inhalers suggests that the user’s asthma is not well controlled and could be undertreated.
Overall, they found that more White patients used ICS, LABA, and LAMA inhalers, but fewer SABA inhalers, compared with the other groups. After adjusting for ethnicity and socioeconomic factors, the researchers broke down some inhaler usage as follows: 30% of Asian patients, 34% of Black patients, and 35% of Hispanic patients used ICSs, compared with 39% of White patients; 21% of Asian patients, 27% of Black patients, and 25% of Hispanic patients used LABAs, compared with 32% of White patients; and 3% of Asian and Hispanic patients, and 4% of Black patients used LAMAs, compared with 6% of White patients.
The researchers found no statistically significant differences in SABA use among the different groups.
“Observed racial and ethnic differences in ICS utilization were mostly, but not completely, attenuated in the fully adjusted model, suggesting sociodemographic and health care access factors are key drivers of treatment variation,” the researchers wrote. “However, these factors—including income, education, insurance status, and access to specialty care—are themselves affected by racial and ethnic disparities, underscoring the complexity of achieving pharmacoequity.”
The researchers were particularly surprised that the widest gap was in the short-acting inhalers, which are easier to obtain and generally less expensive.
“Again, that underscores the complexity of treating asthma when policies change and guidelines change in terms of what is recommended versus not recommended, which doctors have access to those guidelines, and how patients change their treatment based on those new guidelines,” Essien said.
There is still much to learn, and research is needed into physicians’ prescribing behavior. “That may be a question that comes up in terms of next steps, and that’s something that we’re hoping to do in our future work,” Essien said.
Dr. Jing Ren, health sciences clinical instructor of medicine in the Division of Pulmonology, Critical Care, and Sleep Medicine at the David Geffen School of Medicine, led the study. Dr. Ashkan Ara of UCLA and Dr. Christopher Scannell of USC coauthored the paper.
Funding: The National Heart, Lung, and Blood Institute partially funded this study.
Published in journal: JAMA
Title: Disparities in Inhaler Utilization Among US Adults With Asthma
Authors: Jing Ren, MD, Ashkan F. Ara, MD, MPH, Utibe R. Essien, MD, MPH, and Christopher Scannell, MD, PhD
Source/Credit: University of California, Los Angeles / Health
Edited by: Scientific Frontline
Reference Number: med052426_01
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