Asthma is a chronic condition that impacts the airways of the lungs, making it difficult to breathe. If asthma isn't diagnosed and treated, it can cause serious and potentially life-threatening complications.¹

While statistics show that people from Black, Latinx, and Indigenous communities are more likely to develop asthma, they may also experience unnecessary delays in being diagnosed and treated.² There are many reasons for these barriers, including issues related to accessing care and medication costs.

This article discusses the many obstacles that people of color often face in receiving a diagnosis and treatment for asthma.

Asthma Diagnosis Statistics and Race Disparities

When asthma is diagnosed early, it can be treated properly with medications like inhaled corticosteroids, which can lead to better long-term health outcomes. Without a diagnosis, appropriate treatment and care can't be accessed.³

Children who receive a delayed asthma diagnosis are much more likely to seek treatment at an urgent care center compared to those who receive a timely diagnosis.³

While global scientific research on asthma has traditionally been focused on White populations, some studies, especially more recent ones, have demonstrated the barriers that people of color face in asthma diagnosis and treatment.⁴ For example:

• Asthma-related emergency room and urgent care visits are higher in Black and Latinx children than in White children.⁵⁶
• According to one study, roughly 20% of Black, Latinx, and Asian American adolescents living in urban areas who reported having asthma-like symptoms did not receive an asthma diagnosis.⁷

What Are Some Barriers to Diagnosis?

People of color in the United States face disparities in access to health care, the quality of care they receive, and outcomes. In general, they're likely to face longer delays in getting a diagnosis and receive significantly different levels of treatment for various medical conditions compared to White patients.⁸

A variety of socioeconomic, structural, and behavioral factors have been linked to the barriers that people of color face in receiving medical diagnoses.

Access to Care and Health Insurance

Many patients of color may not be able to get an asthma diagnosis because they don't have access to a healthcare provider or health insurance, making it difficult to receive necessary medical care.⁹

Examples of this include:

• If a person doesn't have reliable transportation to a healthcare provider's office
• If a person is unable to take time off from work for an appointment
• If there are no asthma specialists in their area

Research has found many issues related to access to care that serve as major barriers to a timely medical diagnosis.

One study discovered that the lack of a regular healthcare provider or specialist affected asthma treatment options for children of color. It found that, compared to their White peers, Latinx children are more likely to receive urgent asthma care at community health centers, and Black children are more likely to receive asthma care at emergency rooms.¹⁰

Medication and Testing Costs

Just like other health conditions that require specialty care, the cost of managing asthma is a burden for many families, even those who have health insurance or use patient assistance programs.

Income inequality disproportionately impacts Black and Latinx communities, particularly those living in urban communities, which affects their ability to afford the copays needed to fill asthma prescription medications.^11 12

In addition, transportation and childcare expenses associated with getting to the pharmacy can add up quickly.

To put this into perspective, estimated out-of-pocket costs for Dupixent (dupilumab), a specialty medication sometimes used for moderate to severe asthma, can be as much as $45,600 a year. This cost alone—higher than many annual salaries in the United States—shows the significant financial barriers to getting asthma treatment for patients in low-income households.¹³

Family/Cultural Dynamics and Knowledge

Culturally competent care—generally defined as the ability of a healthcare provider to meet the social, cultural, and linguistic needs of a patient—can lead to timely diagnoses and better treatment.

Patients of color are likely to have cultural differences from White populations, which healthcare providers should take into consideration before an asthma diagnosis. Some of these dynamics and beliefs include:

• Higher levels of distrust in the U.S. healthcare system: Patients of color are more likely to report physician or healthcare setting mistrust due to a longstanding history of exploitative clinical research and mistreatment in the United States.¹⁴ This can make it difficult to connect with a consistent healthcare provider and receive an asthma diagnosis.
• Familial or cultural beliefs about medicine and preferred treatment patterns: As one study found, asthma patients with caregivers who were born abroad may not be accustomed to getting preventive management care for conditions like asthma.^15 16
• Language proficiency, literacy, and communication differences:Historically, the U.S. healthcare system has been largely unaccommodating of language or cultural differences. This results in lower medical diagnosis rates for patients with limited English proficiency. As one older study uncovered, a common reason for a delayed asthma diagnosis was the healthcare providers' lack of attention to the patients' communication about symptom history.¹⁷

Implicit Bias in Healthcare Settings

Many studies have highlighted the implicit biases (unconscious attitudes or behaviors toward a person or group of people) that healthcare providers may show toward patients of color.¹⁸

In doing so, they may present a positive attitude toward White patients and a negative or skeptical attitude toward people of color. Too often, emphasizing a patient's race or ethnicity in medical decision-making leads to diagnosis delays and a lack of appropriate treatment for people of color.¹⁹

Risks of Misdiagnosis

If left untreated or misdiagnosed, asthma can lead to serious health complications and a higher risk of hospitalization. Some of these risks include:²⁰

• Obstructive sleep apnea
• Chronic lung inflammation
• Permanent structural changes in the airways of the lungs
• Anxiety or depression
• Complications from pneumonia, the flu, or other respiratory infections

If asthma is severe and has not been diagnosed or properly treated, an attack can lead to respiratory failure (when your lungs can’t get enough oxygen into your bloodstream), which can be fatal.

Equitable Care for People With Asthma

Equitable care means that a person’s racial or ethnic background, socioeconomic status, or other circumstances do not impact their chances of attaining high-quality health care and health outcomes.

Where to Go

When looking for assistance with asthma care, start with your local health department or a trusted community health organization. They should be equipped to provide you with a referral for accessible care.

Next, remember that healthcare providers (whether or not they provide direct care for asthma) are there to help you manage your asthma and overall health. It’s worth asking if the office or healthcare system has additional staff dedicated to helping you better understand your asthma treatment plan or answering questions like how to best use your asthma medications.

Resources for Asthma Care

For additional asthma care options, the Centers for Disease Control and Prevention (CDC) provides an online resource listing state and local asthma resources and providers.

Financial Assistance

Asthma medications and care can be very expensive, even if you have health insurance. Healthcare providers are well aware of this, so you shouldn’t feel shy about informing them if you can’t pay for drugs or care. Your provider wants you to take your medication so that you feel better, and they may know of a program or contact to help you with the cost.

Some financial assistance options include:

• Checking with a clinical social worker: If you feel comfortable, your healthcare provider can give you a referral to the social worker who serves in their office, who can help provide access to grants and other programs for assistance with healthcare needs.
• Using a prescription assistance program (PAP) or copay assistance program (CAP): Pharmaceutical companies offer PAPs to help cut down on drug costs and increase access to asthma medications by providing inhalers and other drugs free of charge or at highly discounted prices to lower-income individuals and families. Alternatively, CAPs cover a portion of drug copay costs for people who have health insurance.
• Seek assistance with organizations like the Partnership for Prescription Assistance:This free online database outlines thousands of medications available at a reduced or no-cost price and helps patients determine eligibility or apply for assistance.

Prescription Assistance Programs

Don't be afraid to ask your healthcare provider's office for information about these assistance programs for some of the asthma drugs they routinely prescribe. Expect to fill out an application that will be submitted to the drug manufacturer for coverage approval.

Advocacy and Outreach Programs

Getting help when you need it is important for managing asthma, whether that assistance is via friends, family, or a healthcare team. But not everyone has direct access to that support. Fortunately, there are nationwide organizations that exist to support people with asthma, including people from all backgrounds and communities.

To start, you may be interested in looking into the following groups:

• The Asthma and Allergy Foundation of America has a patient group that supports people with asthma through advocacy, education, and research.
• The American Lung Association’s Better Breathers Club offers in-person and online patient support groups so that you can connect with other people and families coping with asthma.
• The Allergy & Asthma Network, through its Not One More Life Trusted Messengers Program, offers asthma screenings geared toward communities of color in cities across the United States, with resources available in English and Spanish and a focus on training healthcare professionals to provide equitable asthma outreach care.

Nonemergency Asthma Assistance

Do you need asthma assistance that’s not an emergency? Consider the American Lung Association’s Lung HelpLine for questions, concerns, or additional resources. Staff can answer questions about managing asthma, financial aid, finding an asthma specialist, local resources, medications, respiratory therapy, and connecting with support groups. This free service is available to assist you in English, Spanish, and numerous other languages by calling 1-800-LUNGUSA or via live chat on the website.

Summary

People of color face multiple barriers in receiving an asthma diagnosis and treatment when compared to the White population. For people of color, the likelihood of visiting an emergency room for an asthma episode and experiencing severe or fatal complications from asthma is much higher than it is in White patients, partly due to misdiagnosis or delayed diagnosis.

Research shows that factors like a lack of accessible medical care, disparities in health insurance, high medication costs, and familial or cultural dynamics play a role in creating obstacles to asthma diagnosis and treatment.

A Word From Verywell

Dealing with a chronic health condition like asthma is stressful, especially when there are unnecessary barriers to receiving a diagnosis. While getting a diagnosis for yourself or a family member is just the first step, it's an essential part of the process. Don't be afraid to lean on an extended support network of friends, family, community members, and support groups for extra encouragement along the way.

Frequently Asked Questions

Is there a link between asthma and poverty?

Asthma disproportionately affects low-income populations. Research has shown that low-income environments are linked to the development of asthma due to exposures to pollution, allergens, and chronic stress.²¹

Black, Latinx, and other children living in households near the federal poverty level have twice the risk of developing asthma, higher hospitalization and emergency room visits, and more deaths linked to asthma compared to their White counterparts.^10 6

What can people living in cities do to reduce asthma risk?

Exposure to pollution that is common in cities is linked to a greater risk of asthma. While you may not be able to control what’s happening externally, experts suggest reducing indoor allergens at home, as triggers like tobacco smoke, dust mites, cockroaches, and pet dander can aggravate asthma.²²

If accessible to you, try to vacuum regularly, keep surfaces clean, close windows and doors when possible, and reduce moisture in the bathroom and kitchen areas.

Do children grow out of asthma?

It's possible for people to develop asthma in childhood and then grow out of it after several years. Keep in mind, though, that symptoms can come back at any time. Always check with a healthcare provider before stopping or making changes to an asthma medication plan.

What should I do if I cannot afford asthma treatment?

First, tell your healthcare provider or another trusted source who can help communicate this to the provider’s office for you. They’ll be able to refer you to prescription assistance programs that offer asthma drugs free of charge or at highly discounted rates for lower-income patients. You might also be able to access discounts through pharmacy or prescription savings programs such as GoodRx or Blink Health.

SOURCES

1. Asthma and Allergy Foundation of America. What are the symptoms of asthma?.
2. Asthma and Allergy Foundation of America. Asthma disparities in America.
3. Seol HY, Sohn S, Liu H, et al. Early identification of childhood asthma: the role of informatics in an era of electronic health records. Front Pediatr. 2019;7:113. doi:10.3389/fped.2019.00113
4. Hull SA, McKibben S, Homer K, Taylor S JC, Pike K, Griffiths C. Asthma prescribing, ethnicity and risk of hospital admission: an analysis of 35,864 linked primary and secondary care records in East London. NPJ Prim Care Respir Med. 2016;26:16049. doi:10.1038/npjpcrm.2016.49
5. Centers for Disease Control and Prevention. Asthma emergency department (ED) visits 2010–2018.
6. Centers for Disease Control and Prevention. Asthma in children.
7. Bruzzese JM, Kingston S, Falletta KA, Bruzelius E, Poghosyan L. Individual and neighborhood factors associated with undiagnosed asthma in a large cohort of urban adolescents. J Urban Health. 2019;96(2):252-261. doi:10.1007/s11524-018-00340-2
8. Smith EC, Ziogas A, Anton-Culver H. Delay in surgical treatment and survival after breast cancer diagnosis in young women by race/ethnicity. JAMA Surg. 2013;148(6):516–523. doi:10.1001/jamasurg.2013.1680
9. Perez MF, Coutinho MT. An overview of health disparities in asthma. Yale J Biol Med. 2021;94(3):497-507.
10. Kaufmann J, Marino M, Lucas J, et al. Racial and ethnic disparities in acute care Use for pediatric asthma. Ann Fam Med. 2022;20(2):116-122. doi:10.1370/afm.2771
11. Asthma and Allergy Foundation of America. Ethnic disparities in the burden and treatment of asthma.
12. Bollinger ME, Mudd KE, Boldt A, Hsu VD, Tsoukleris MG, Butz AM. Prescription fill patterns in underserved children with asthma receiving subspecialty care. Ann Allergy Asthma Immunol. 2013;111(3):185-189. doi:10.1016/j.anai.2013.06.009
13. González Burchard E, Borrell LN. Need for racial and ethnic diversity in asthma precision medicine. N Engl J Med. 2021;385:2287-2298. doi:10.1056/NEJMe2114944
14. Powell W, Richmond J, Mohottige D, Yen I, Joslyn A, Corbie-Smith G. Medical mistrust, racism, and delays in preventive health screening among African-American men. Behav Med. 2019;45(2):102-117. doi:10.1080/08964289.2019.1585327
15. Koinis-Mitchell D, Sato AF, Kopel SJ, et al. Immigration and acculturation-related factors and asthma morbidity in Latino children. J Pediatr Psychol. 2011;36(10):1130-1143. doi:10.1093/jpepsy/jsr041
16. Banta JE, Ramadan M, Alhusseini N, et al. Socio-demographics and asthma prevalence, management, and outcomes among children 1–11 years of age in California. Glob Health Res Policy. 2021;6(17). doi:10.1186/s41256-021-00199-y
17. Østergaard MS. Childhood asthma: reasons for diagnostic delay and facilitation of early diagnosis--a qualitative study. Prim Care Respir J. 2005;14(1):25-30. doi:10.1016/j.pcrj.2004.06.008
18. Hall WJ, Chapman MV, Lee KM, et al. Implicit racial/ethnic bias among health care professionals and its influence on health care outcomes: A systematic review. Am J Public Health. 2015;105(12):e60-e76. doi:10.2105/AJPH.2015.302903
19. Kaiser Family Foundation. Use of race in clinical decision making: Overview and implications.
20. American Lung Association. Severe asthma.
21. Louisias M, Phipatanakul W. Managing asthma in low-income, underrepresented minority, and other disadvantaged pediatric populations: closing the gap. Curr Allergy Asthma Rep. 2017;17(10):68. doi:10.1007/s11882-017-0734-x
22.  Centers for Disease Control and Prevention. Common asthma triggers.

Asthma is a lung disease that restricts the airways, making it difficult to breathe. It is one of the most common chronic illnesses in the United States, but some populations are more affected than others. Data shows that people from Black, Latinx, and Indigenous communities develop asthma at much higher rates than White Americans, and are more likely to be hospitalized and suffer complications.¹

While the reasons for these disparities are complex, experts have highlighted an increased exposure to poor air quality and lack of access to health care as some contributing factors.

This article provides an overview of the increased risk of asthma in people of color and discusses equitable treatment options.

Asthma Statistics and Race Disparities

In the United States, asthma and its complications affect Black, Latinx, and Indigenous communities disproportionately when compared to White populations.

Some statistics to put the disparities into perspective include:²

• Black Americans are 1.5 times more likely to have asthma, five times more likely to visit an emergency room due to asthma symptoms, and three times more likely to die from an asthma episode when compared to White Americans.
• Puerto Rican Americans are more likely to have asthma compared to any other ethnic group, and are two times more likely to experience asthma attacks than White Americans.
• Indigenous Americans have the highest rates of asthma and are almost twice as likely to experience asthma symptoms on a daily basis compared to White Americans.³
• Mexican American children are twice as likely to be hospitalized for asthma compared to their White counterparts, and have rates of asthma that are increasing quicker than all other ethnic and racial groups.⁴

Defining Race, Ethnicity, and Health Disparities

The following definitions help describe how health outcomes intersect with different populations of people:⁵

• Race is a socially constructed term that was created to categorize people based on a description of their physical traits (for example, White, Black, Asian).
• Ethnicity is a broader term used to describe a person's cultural identification, which may or may not be their place of ancestral origin (for example, Italian, Lebanese, Cuban).
• Health disparities andhealth inequities are technically different terms, but often interchangeably refer to avoidable differences in the health of different population groups. These differences are driven by social, economic, or structural factors that may be rooted in racism.

What Factors Increase Asthma Risk in People of Color?

There are several different structural, social, and behavioral factors that increase asthma rates in communities of color, including genetics, increased exposure to pollution or allergens, and reduced access to high-quality health care.⁶

Genetics

Experts generally agree that there is a genetic component that increases the risk of asthma. Recent research shows some evidence of this, as people of African ancestry in other countries also appear to have higher rates of asthma, similar to Black Americans.⁷

But having a gene in your DNA doesn't automatically mean you'll develop asthma. Environmental factors must also be present, so genetics is only one part of the explanation for asthma disparities.⁸

To Keep in Mind

Much of the existing genetic research on the causes of asthma has been conducted on White populations, so it's not possible to generalize this data for people of other ethnic and racial backgrounds.⁹

Environment

Your surroundings can greatly impact your asthma. A person’s physical environment plays a big role in asthma outcomes because asthma is often triggered by an irritant. These can include:¹⁰

• Cigarette smoke
• Air pollution
• Dust 
• Chemical fumes
• Pet dander  

For people of color in lower-income neighborhoods, living environment and air quality are significant drivers for developing asthma.¹¹ This is due to the lower-quality building structures and more frequent exposure to outdoor pollution.

According to the Centers for Disease Control and Prevention (CDC), children who live in those areas or live in households below the federal poverty level have higher rates of asthma.¹²

Access to Health Care

Being able to access timely and affordable health care is a crucial and often lifesaving part of maintaining a treatment plan for asthma. It's well-documented that people of color are more likely to experience unequal access to health care and health insurance.¹³¹⁴

Other barriers that limit access to health care for asthma include:

• Lack of health insurance
• Inability to take paid time off of work
• Unreliable transportation to medical appointments

Data shows that Black and Latinx children with asthma are less likely to have a regular healthcare provider and more likely to use the emergency department as a form of medical care than White children.¹⁵ They're also less likely than White children to be prescribed or take recommended treatments to control their asthma.¹⁶

Behavioral and Cultural Factors

Internal factors like a person's beliefs, behaviors, and cultural upbringing play a role in how a person understands and manages a chronic condition like asthma.¹⁷

Mistrust of the medical system exists in many communities of color due to longstanding historical injustices, mistreatment, and exploitation across generations.¹⁸ This mistrust may be further solidified in first- or second-generation immigrants of color, who may forgo medical treatment for urgent conditions like asthma due to fear, language differences, or other barriers to seeking care.¹⁹²⁰

Chronic Stress and Discrimination

Black, Latinx, and Indigenous American communities have increased exposure to chronic stress in the form of racism and discrimination, violence, and economic disparities.²¹ Evidence points to a link between this type of stress and asthma development, worsening symptoms, and less effective treatment.²²

Some findings have also indicated that it may begin in the womb, showing a connection between long-term maternal stress and an increased risk of childhood asthma.²³

Asthma Severity in People of Color

Not only are people of color at a greater risk of developing asthma, their asthma cases turn out to be more severe than asthma cases in White populations.

As a staggering example, recent data indicates that Black and Latinx people experience twice as many emergency room visits and deaths due to asthma as White people.²⁴ Figures also show that Black women are the most likely to die from asthma than women from any other racial or ethnic group.²⁵

What's more, many experts hypothesize that these figures are likely underestimated and could be higher. People of color have often been broadly excluded from asthma research, and there's a lack of available data for Indigenous populations.

Equitable Asthma Programs and Treatment

So far, equitable outreach programs and policies in the U.S. have only scratched the surface in addressing disparities in asthma. Because the inequities are complex, solutions will require a multifaceted approach across medicine.

Some local, state, and nationally-based programs have taken steps toward this goal, including:²⁶

• American Lung Association's Asthma-Friendly Schools initiative offers tools to schools and communities to improve asthma outcomes in children.
• Nationwide Children’s School-Based Asthma Therapy Program, a group that facilitates asthma care plans and prevention medications for children at school.
• Boston Children's Hospital Community Asthma Initiative aims to improve rates of hospitalization and emergency room visits for children of color with asthma.
• Breathe DC is a nonprofit community organization in Washington, D.C., that aims to combat lung diseases like asthma while promoting healthy lifestyles.

Summary

Asthma is a chronic lung disease that causes difficulty breathing. It is a common condition in the United States, but people of color are disproportionately impacted by asthma compared to White populations.

Health inequities in asthma exist for a variety of complex reasons. However, experts suspect that disparities in access to health care, environmental exposure to allergens, chronic stress from discrimination, and genetics likely play a role in the increased risk of asthma in people of color.

A Word From Verywell

Coping with asthma as a person of color can be difficult, particularly when there's the added stress of potentially discriminatory experiences and substandard access to medical care and treatment. Remember that you are not at fault for being diagnosed with asthma. Do what you can to avoid asthma triggers and advocate for better treatment if you feel it's needed.

Frequently Asked Questions

What is the main cause of asthma disparities in Black people?

Black people face inequities in asthma largely due to socioeconomic factors, such as lower-quality housing and unequal access to health care. These populations routinely experience greater exposure to asthma triggers and less access to asthma specialists than White populations in the U.S.

How do you recognize asthma in children?

Children typically experience the same asthma symptoms as adults, such as wheezing, coughing, and shortness of breath. However, a child may not know how to verbalize how they're feeling. Look for subtle signs, like slow recovery from respiratory illnesses, fatigue, trouble swallowing while eating, and avoiding physical activity.²⁷

Why do asthma health disparities exist?

Factors like socioeconomic status, environment, and access to health care or health insurance are underlying drivers for asthma health disparities in the U.S. Other behavioral and biological factors, such as cigarette smoking and genetics, also play a smaller role.

What asthma resources are available to people of color?

Healthcare providers, school nurses, and local health departments should be willing to provide you with equitable resources, contacts, referrals, and services for asthma care. You might also check the Asthma and Allergy Foundation of America or the Allergy and Asthma Network for help in English or Spanish.

SOURCES

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