The Asthma and Allergy Foundation of America …

1 Ethnic Disparities in the Burdenand Treatment of AsthmaTheAsthma and Allergy Foundation of AmericaThe national pharmaceutical council January, 2005 by the Asthma and Allergy Foundation of America and the national pharmaceutical CouncilAbout the Asthma and AllergyFoundation of America ( )AAFA is the premier patient organization dedicated toimproving the quality of life for people with Asthma andallergies and their families through education, advocacy, andresearch. AAFA, a not-for-profit organization founded in1953, provides practical information, community basedservices, support, and referrals through a national networkof chapters and educational support groups.

2 AAFA alsoraises funds for Asthma and Allergy the national PharmaceuticalCouncil ( )Since 1953, NPC has sponsored and conducted scientific,evidence-based analyses of the appropriate use ofpharmaceuticals and the clinical and economic value ofpharmaceutical innovations. NPC provides educationalresources to a variety of health care stakeholders, includingpatients, clinicians, payers, and policy makers. More than 20 research-based pharmaceutical companies are membersof report was prepared by AAFA Policy Director Mo Mayrides and NPC Vice President Richard Levy incollaboration with SCRIBCO.

3 Deborah Kline and JeanPolatsek of NPC contributed editorial support and AnjuKanumalla in association with SCRIBCO provided medicalwriting and NPC thank the following individuals for theirgenerous time, advice and expertise in reviewing the factualcontent of this paper: Peter Gergen, MD, MPHM edical OfficerAsthma, Allergy and Inflammation BranchAsthma and Inflammation SectionNational Institute of Allergy and Infectious DiseasesNational Institutes of HealthDavid L. N ez, MD, MPHC hief, California Asthma Public Health InitiativeMedicine and Public Health SectionCalifornia Department of Health ServicesAny errors in this publication are the responsibility of AAFAand copies of this report may be ordered fromAAFA or NPC.

4 Please address inquires to: Asthma and Allergy Foundation of AmericaAttn: Mo pharmaceutical Council1894 Preston White DriveReston, VA Findings In the United States the burden of Asthma fallsdisproportionately on the black and Hispanic largelyPuerto Rican populations, and especially on minoritychildren. These groups have disproportionately high ratesof poor Asthma outcomes, including hospitalizations anddeaths. This burden has environmental, socioeconomic,and behavioral causes. As much as 40 percent of the risk of Asthma in minoritychildren is attributable to exposure to residential allergensthat could be reduced, if not eliminated.

5 Access to care ishampered by socioeconomic disparities, shortages ofprimary care physicians in minority communities, andlanguage and literacy barriers. A pattern of health carebehavior characterized by the underuse of long-termcontrol medications and a reliance on episodic andemergency care is common in black and HispanicAmericans with Asthma . Underuse of Asthma medicines, especially of long-termcontrol medications, is more common in minority than inwhite children. Specifically, minority children are less likelythan white children to use inhaled corticosteroids, whichare recommended long-term control medications.

6 Underuse of Asthma medications can reflect breakdownalong the sequence of behaviors required for adequatetherapy: (1) under-prescribing, (2) not filling prescriptions,and (3) poor compliance with filled prescriptions. Failure ateach of these stages has been reported for minoritychildren with Asthma , in some cases at a higher rate thanfor white children. Adherence to Asthma medication regimens in minoritychildren may be compromised by their parents beliefsabout the role and usefulness of medications, concernsabout adverse effects, poor literacy, and distrust of andpoor communication with physicians.

7 Individualized,culturally sensitive communication with minority familiescan help avoid these problems. Increasing theuse of long-termcontrolmedications iskey to reducingdisparities in theburden useof suchmedications, especially within the context of asthmamanagement programs, can reduce the use of emergencycare and alleviate the burden of childhood Asthma inminorities. Asthma education and management programs designedfor minority groups can teach them how to use medicationinhalers correctly, correct false impressions aboutmedications, and explain the role of environmental number of such programs have been tested, particularlyamong minority children, with demonstrable success.

8 Thewidespread adoption of such programs could potentiallyalleviate a large proportion of the burden of Asthma inminority children and the United States the burden of Asthma fallsdisproportionately on the black and Hispanic largely PuertoRican populations. This disparity is the subject of thisreport. Although the report is concerned with minoritypopulations as a whole, much of the material presentedapplies specifically to minority children, who are mostaffected by and Puerto Rican populations have disproportionatelyhigh rates of poor Asthma outcomes, includinghospitalizations and deaths.

9 Much of this disparity has beenattributed to unequal access to preventive care. Black andPuerto Rican children characteristically under-use routinehealth care services and overuse emergency care servicesfor Asthma . Environmental, socioeconomic, and behavioralfactors all contribute. Childhood Asthma is closelyassociated with environmental exposures, particularly toresidential allergens, that could be reduced if not programs designed to control Asthma andprevent symptom outbreaks focus on avoidance ofenvironmental triggers and proper use of asthmamedications.

10 Effective medications are available for the long-term controlof Asthma and for quick relief of symptom of these medicines, especially of long-term controlmedications, is more common in minority than in whitechildren. Specifically, minority children are less likely thanwhite children to use inhaled corticosteroids, which arerecommended long-term control medications. Theconsistent use of these medications, especially within thecontext of Asthma management programs, can reduce theuse of emergency care and alleviate the burden of childhoodasthma in report contains three chapters, the first of whichdiscusses disparities in the burden of Asthma on the blackand Hispanic populations as compared with the whitepopulation.