African-American and Hispanic adults with asthma were more likely to be treated in the emergency department (ED) than non-Hispanic whites, but were less likely to report on uncontrolled daytime symptoms of asthma, according to research from the cancelled American Academy of Allergy Asthma and Immunology (AAAAI) annual meeting.
“After controlling for factors including income, education, and health insurance, African-American and Hispanic respondents were twice as likely to visit the [ED] for asthma (P<0.001), yet 40% less likely to report uncontrolled daytime symptoms (P=0.004 for African Americans) and (P=0.006 for Hispanic patients),” reported Nicole Cremer, MD, of the University of Michigan in Ann Arbor, and colleagues (Abstract 341).
The authors accessed data on 4,700 individuals in the 2015 Behavioral Risk Factor Surveillance Survey and Asthma Call-Back Survey, and analyzed patterns of treatment among patients who were at least age 55 and had a current asthma diagnosis. Race was self-reported.
“The number of older adults with asthma continues to rise, yet the effects of race and ethnicity on asthma outcomes in this population are unknown,” they wrote.
In comparison with non-Hispanic whites, African-American and Hispanic respondents had lower incomes; reported greater impaired access to healthcare due to costs; and reported increased reliance on rescue medications.
“Racial differences in asthma outcomes persist despite controlling for multiple social determinants of health and access to health insurance through Medicare,” Cremer’s group reported. “These findings indicate that comprehensive strategies to address assessment, monitoring, and treatment are needed to decrease health disparities.”
Other AAAAI abstracts looked at ED use by younger people with asthma, how Medicaid expansion impacted asthma patients, asthma and physical activity, and antibiotics in pregnant women with asthma.
Asthma Care Transition
Young adults with asthma who were transitioning from pediatric to adult care used the ED for the treatment of exacerbations, were more likely to have public insurance, and be current smokers, reported researchers at the Hospital of the University of Pennsylvania in Philadelphia (Abstract 349).
Priya Patel, MD, and colleagues identified 1,177 patients (ages 18-25 years; 67% women) who had an asthma-related ED visit at their institution from 2015-2018. Patients were stratified by ED use, with high utilizers making two visits a year and very high utilizers making three or more visits annually.
About 4% of the patients were very high utilizers and 10% were high utilizers. Information on demographics, insurance status, comorbid atopic and non-atopic medical conditions, smoking status, asthma medications, and whether the patient had a primary care provider or asthma specialist were collectively retrospectively.
“Very high utilizers were more likely to be black (P=0.044), more likely to have public insurance (P=0.041), and were more likely to have a smoking history (P=0.027),” Patel’s group reported. Atopic conditions such as allergic rhinitis, atopic dermatitis, food allergy, obesity, having a documented primary care physician, or having an asthma care specialist were not associated with high utilization, the authors noted.
“The challenges obtaining healthcare for young adults with asthma as they transition to independent living is not known,” they stated. “Poverty and smoking should be addressed as young adults are transitioned to managing asthma and health care as adults.”
The expansion of Medicaid under the Affordable Care Act significantly increased the ability of low-income asthma patients to get health insurance, and reduced cost barriers to treatment, according to Joy Hsu, MD, of the CDC National Asthma Control Program in Atlanta, and colleagues (Abstract 338).
In 2014, 26 states and Puerto Rico expanded Medicaid eligibility to include more low-income adults. “We investigated health insurance coverage and cost barriers to care before and after 2014 among low-income adults with asthma,” the authors wrote. “We analyzed the Behavioral Risk Factor Surveillance System Asthma Call-Back Survey, a state-level, health-related telephone survey, data from low income adults with asthma, ages 18-64, in Medicaid expansion jurisdictions and non-Medicaid expansion jurisdictions in 2012-2013, and 2015-2016.”
They included 6,760 individuals with low income and an asthma diagnosis. Among individuals from states that accepted the Medicaid expansion, health insurance coverage increased from 77.1% in 2012-2013 to 91.9% in 2015-2016 (P<0.00005), they reported.
Cost barriers to healthcare in this same group was reported by 36.2% of the individuals in the earlier time-frame, and that number decreased to 28.8% in the 2-year period following Medicaid expansion.
Physical Activity Deficit
While physical activity is recommended by national guidelines for people living with asthma, clinicians did not discuss the topic with their patients enough, according to researchers at the Institute for Health Research and Policy at the University of Illinois in Chicago (Abstract 352).
Less than half of the physicians who treated asthma patients responded in surveys that they recommend physical activity to their patients, and 60% of the clinicians who responded said that they only suggested physical activity some of the time, reported Lisa Sharp, PhD, and colleagues.
They sent a 10-item survey to primary care physicians, family medicine doctors, internal medicine specialists, and asthma specialists, and received responses from 75 clinicians (about 19% response rate).
Primary care physicians were more likely to indicate they were unsure of the evidence supporting physical activity promotion for asthma patients versus asthma specialists (40.67% vs 25%). The most common barrier to suggesting physical activity cited by primary care physicians was time constraints (26.67% of the respondents). Asthma specialists reported lack of patient interest (53.3%) as the most common barrier. Other barriers included a lack of training in physical activity education and consideration of other comorbidities.
“Physical activity counseling in asthma patients is low,” the researchers reported. “This study provides preliminary data that will propel further research on improving physical activity counseling by health care providers in patients with asthma.”
Antibiotics in Pregnancy
Pregnant women with asthma were more likely than non-asthmatic women to use antibiotics during the course of their pregnancy, according to research from Vanderbilt University in Nashville (Abstract 357).
Megan Patterson, MD, and colleagues accessed records of a state Medicaid program, and identified 84,214 pregnant women, 4.5% of whom had an asthma diagnosis. They focused on which of those women received prescriptions for prenatal antibiotics, based on hospital code records.
The analysis indicated that 82% of the women with asthma were prescribed antibiotics compared with 63% of women who did not have an asthma diagnosis. “Women with asthma had a 2.5-fold increase in odds of ever being prescribed antibiotics compared to those without asthma,” Patterson and colleagues reported (adjusted OR 2.46, 95% CI 2.26, 2.67).
Also, among antibiotic users, women with asthma were at increased odds of receiving a greater number of courses of antibiotics (aOR 1.89, 95% CI 1.77, 2.02) and had earlier time to first antibiotic fill in pregnancy, they stated.
“Future assessment to determine whether pregnant asthmatics are at higher infection risk or antibiotics are being used to treat asthma exacerbations may inform clinical decision making,” they wrote.