Why are African Americans at higher risk of asthma?

Asthma disproportionately affects certain populations, including African American people. The reasons for this are complex and varied.

Asthma is a long-term lung condition that can affect people of all ages, sexes, races, and ethnic backgrounds.

However, for numerous reasons — including certain socioeconomic factors — the risks of both hospitalization and death from asthma are higher in African American people.

This article will look at the reasons behind this increased risk of asthma in African American people. It will also include some general information about the causes, treatments, and prevention methods associated with this chronic respiratory condition.

Risk factors for asthma in African Americans

As of 2018, non-Hispanic African American people in the United States have roughly a 40% higher risk of developing asthma than non-Hispanic white people in the U.S.

Furthermore, when the researchers published these data, 10.6% of non-Hispanic Black people in the U.S. had asthma, while only 7.6% of non-Hispanic white people in the U.S. had this condition.

Compared with white people with asthma, African American people with asthma are five times more likely to visit the emergency room for symptoms.

The severity of asthma also tends to be worse in African American people. For instance, Black individuals are almost three times more likely to die from an asthma episode than white people.

Researchers continue to study why African American people are at increased risk of dying from asthma than white people.

One area of study is the type of airway inflammation that might occur more often in African American people, leading to severe and harder-to-treat asthma. Another area that warrants attention is inequities in healthcare.

Causes of higher asthma rates in African Americans

Although research into the differences in the rates of asthma among African American people and other racial groups continues, experts have identified certain factors.

One 2017 study involved 1,018 participants with asthma who self-identified as African American or white. The researchers collected sputum samples from all the participants to identify the presence of eosinophils (white blood cells), which indicate airway inflammation.

The results suggested that the African American participants had greater eosinophilic airway inflammation than white participants, even when taking the same dosage of asthma medication.

Eosinophilic airway inflammation is one of the primary causes of asthma symptoms. It is what leads to difficulty breathing.

The researchers theorize that this increase in airway inflammation may be a cause of more severe asthma in African American people.

However, several other factors also appear to play a role in African American people having a higher risk of asthma, including:

Genetics

Although there is evidence to suggest that social determinants and inequities in healthcare play a role, certain biological factors also appear to be associated with the disparities outlined above.

For example, differences in genes that make someone more susceptible to developing asthma or increase the severity of their asthma symptoms may also explain the higher rates of asthma in African American populations.

A study in the American Journal of Respiratory and Critical Care Medicine examined some possible differences in people’s responses to respiratory medications. The researchers used a cohort of 1,441 African American, Puerto Rican, and Mexican American participants.

The researchers found both common — that is, those that affected all populations — and rare genetic variants associated with a decreased response to albuterol. Albuterol is a bronchodilator that doctors frequently prescribe to treat asthma.

Although research continues, genetic mutations such as these may provide some explanation for the disparities in asthma rates in different racial groups.

Inequities in healthcare

Inequities in healthcare occur for various reasons, including systemic racism and policies that discriminate against African American populations.

Discrimination and racism affect economic stability and, in turn, access to healthcare. A lack of accessible healthcare may lead to a person having poorly managed asthma.

Social determinants

environment and socioeconomic status.

For example, having poor housing conditions and a low income may result in increased exposure to asthma triggers such as mold or higher levels of air pollution.

Low birth weight

Research in the Journal of Health EconomicsTrusted Source suggested that African American children are more likely to be born with low birth weight, which may increase their risk of developing asthma in childhood.

It is possible that issues such as low birth weight also arise due to inequities in healthcare in general and in the level of care that doctors provide to pregnant African American people in particular.

Symptoms:  Symptoms of asthma can vary, and they can vary in severity. The most common symptoms include:

• wheezing
  shortness of breath
  coughing
  excess mucus production
  chest tightness

Diagnosis: Receiving an asthma diagnosis involves undergoing a physical exam. There are also several diagnostic tests that a doctor may use in order to determine the presence of asthma.

These tests include:

Spirometry: Spirometry measures the amount of air a person can inhale and exhale, as well as the speed of inhalation.
Peak flow: Peak flow measures the amount of air a person can quickly blow out.

Chest X-ray: A chest X-ray produces a picture of the lungs. It cannot diagnose asthma specifically, but it can rule out other conditions.

Treatment: Treatment for asthma does not differ according to race or ethnicity. That said, since asthma may be more severe in African American people, finding and following an effective asthma treatment plan is important.

Asthma treatment plans may include a combination of the following:

Taking medications: Prescription medications for asthma may include:

• bronchodilators, which treat constriction or narrowing of the airway
  steroids, which reduce inflammation in the lungs
  a combination of medications containing both steroids and bronchodilators

Reducing triggers: Identifying asthma triggers through careful self-evaluation may help an individual determine what leads to an asthma episode.

Once a person has identified their triggers, finding ways to reduce exposure to them can significantly decrease asthma episodes.

Receiving allergy shots: In some cases, asthma episodes occur in response to an allergen. Receiving allergy shots may gradually allow an individual to develop a tolerance to an allergen.

Making certain other lifestyle changes: A number of lifestyle factors, such as exercising regularly and avoiding smoking, are also very important when trying to manage asthma.

Prevention: It may not be possible to prevent all cases of asthma, but there are some ways that both individuals and the community at large can reduce the risk and prevalence of asthma.

These include: 

Not smoking: Smoking during pregnancy or exposing young children to secondhand smoke is a risk factor for children developing asthma. Avoiding smoking can reduce this risk.

Public policy reform: Reforming public policies that decrease healthcare inequities is essential to reducing asthma. Introducing policies that reduce pollution and environmental triggers may also help prevent asthma.

Community education: Introducing community education programs to prevent low birth weight and smoking can help reduce asthma rates in children.

Mobile asthma clinics: Providing easier access to healthcare may decrease asthma in vulnerable populations. Mobile asthma clinics are one option to allow better access to neighborhoods.

Summary: The risk of developing asthma and the risk of dying from an asthma episode is higher in African American people than white American people.

These differences are likely due to a combination of factors, including healthcare inequities stemming from discrimination, genetics (possibly), and certain social and economic determinants.

Introducing policies that address factors such as inequities in healthcare and community asthma education programs may help prevent or decrease the severity of asthma in African American people.