No longer a media darling, the breathing disorder still hits black communities hard
Asthma, a chronic inflammatory disease of the airways characterized by breathing disorders, afflicts 18.7 million adults and 7 million children in this country. And, according to the Centers for Disease Control and Prevention, those numbers are rising.
Among black folks, the numbers are particularly distressing. We have a 35 percent higher rate of asthma than whites, and that disparity is evident across all age groups. According to the CDC, the number of Americans diagnosed with asthma increased by 4.3 million from 2001 to 2009, most steeply among black children. One survey of Chicago schoolchildren ages 6 to 12 found that African Americans were more than twice as likely to have been diagnosed with asthma compared to their white counterparts.
Michael A. Lenoir, M.D., a Bay area allergist and past president of the National Medical Association (NMA), spoke with Black Health Matters about the challenges of fighting this disease.
Black Health Matters: What should we know about asthma right now?
Michael A. Lenoir, M.D.: We understand more about the disease and the triggers, so we can tailor treatment. We got anti-inflammatories, and mortality started to drop. But a lot of the interest from the first part of the last decade has been kind of lost. We’re starting to see people revert to old ways of therapy. For a long time we used Albuterol. It’s easy to get, it’s easy to use and it works. It opens the airway, no matter what closes it. The problem is that it’s not a maintenance treatment.
Are physicians not prescribing maintenance medications?
The problem is not that were not prescribing the appropriate medications, but Albuterol is so much easier to take. When you have a disease that when you’re feeling good, you’re feeling good, but when you’re feeling bad, you want relief quick, it’s hard to get people on maintenance drugs to maintain when they know Albuterol works quicker.
Why are African American children more at risk of developing asthma?
It’s really a systemic problem. African Americans are more at risk of everything. One reason is lifestyle; other reasons are access to health care, access to specialists and living in poor environments. There’s a study that says if you look at most ethnic diseases, as people go up the socioeconomic ladder, the incidence of the disease goes down. That’s not true with African Americans and asthma. We haven’t gotten the info out that you can manage this disease, but you have to have regular doctor visits.
That’s another big problem in our community. We see doctors more for illness than for wellness. Getting to the doctor—even when there’s access—we as people, particularly black males, we’re leery to go for regular visits.
What most physicians feel is that asthma rates are increasing because of exposure to hydrocarbons—people living in cities with automobiles and crowding. So even if you use the meds that are available and that are recommended, you still have to fight those factors.
You mentioned access to care. How has the Affordable Care Act helped your patients?
The Affordable Care Act has helped by providing proper insurance for millions of people. More people are covered. More African Americans are covered. Plus there are metrics doctors have to meet in that care. That’s one of the really important values. We’re in a new era in medicine when you start talking about reimbursement for quality not volume. That’s clearly the direction we should go in.
You also said physicians believe exposure to hydrocarbons is behind a rise in asthma rates. But a recent study found that living in an urban area isn’t the biggest risk for a child developing asthma, that being poor, black and Latino are bigger risks.
Environment is still a big risk factor for children. There’s no denying that we live in those [inner-city] environments more often. We’re in those spaces, and our asthma isn’t well managed. That plethora of factors increases morbidity.
Is there a genetic component to who gets asthma?
Yes. If you look at families, probably 60 percent of people with asthma have at least one family member with it. There are also some genetic differences in how we respond to therapy. If you look at Puerto Ricans, 22 percent have the gene that leads to asthma, but don’t respond to meds. Only 8 percent of Mexicans have that gene. Eighteen percent of African Americans have the gene that leads to asthma, but don’t respond to the meds. So genetics is a really major part. In the future, you’ll find that more people will be treated based on genetics.
What about clinical trials? Are there any for asthma, and how can we get more of us into those trials?
I chaired the NMA’s clinical trials project, and one of the biggest barriers is that doctors don’t refer black patients for clinical trials.
And we still remember Tuskegee….
It’s not just Tuskegee—a lot of young people barely know about Tuskegee. Some people are just afraid of experimentation. [The bigger issue is that] we’re not offered clinical trials. There are a lot of large asthma clinical trials that have shown large improvements in care. But we don’t know about them.
And doctors have the same fears about experimentation. I don’t care how you look at it, you’re still a guinea pig.
Let’s face it: Sometimes these trials work, sometimes they don’t. By the time they get to human trials, there’s usually evidence to support them working. But if they don’t have enough African Americans in clinical trials, you have stage four problems after the drug is released—where the drug doesn’t work well for African Americans. That’s another reason to encourage more African Americans to get involved. Plus, a lot of times you get better care while in a clinical trial.
So the bottom line on asthma in African Americans is….
The problem is when these diseases fall out of favor and drug companies leave town, we still have the disease. There’s still a difference between our health and that of other people. We have to look after our own. We have to take care of ourselves in this increasingly complex environment. African Americans still fall way behind the curve. In order to change that in asthma, and any other chronic disease, we have to stay on it. I tell people, if blacks with asthma got as mad about the outcomes as we do when somebody cuts in the Safeway line, we’d have this problem solved.