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Asthma Attacks Decreased Among Black Patients During The Pandemic

Despite Black patients having the highest prevalence of asthma prior to the COVID-19 pandemic, decreasing trends in asthma attacks were observed for this population during the pandemic relative to white patients, according to findings from a national survey study.

Asthma attack rates decreased from 29.3% in 2019 to 22.1% in 2022 among Black adults, with relative adjusted differences between Black and white adults going from +2.3 percentage points to -5.8 percentage points over this time period, reported Adam Gaffney, MD, MPH, of Harvard Medical School in Boston, and co-authors.

Despite the decrease in asthma attacks, emergency department (ED) visits were consistently higher among Black versus white adults, although the adjusted difference narrowed over time, from a 5.2 percentage point difference in 2019 to a 2.6 percentage point difference in 2022, they noted in their Annals of Internal Medicine research letter.

The study included 120,698 adults and 30,708 children included in the National Health Interview Survey from 2019 to 2022. Overall, asthma prevalence among adults increased from 8% in 2019 to 8.7% in 2022, which the researchers said is likely driven by increases among white patients.

"For children, asthma prevalence was stable, but consistently highest among Black children, despite a transient dip in 2020," the authors wrote. Asthma attacks decreased through 2021, but then increased in 2022, especially among white kids compared with Hispanic and Black kids, with an adjusted difference of -13.1 percentage points and -12.4 percentage points, respectively. Rates of ED visits decreased from 17.3% in 2019 to 12.1% in 2022, driven by decreases among Black and Hispanic children, Gaffney and team reported.

"The gradual decrease in ED visits and rebound of asthma attacks in 2022 [in kids] after a small drop may be attributed to a decrease in the circulation of common respiratory viruses," they wrote. "Differential exposure to tobacco, allergens, pollution, COVID-19, or controller inhaler usage during the pandemic could also have affected asthma trends and deserve further study."

"Healthcare avoidance, which likely played a role in 2020, is less likely to explain reductions in subsequent years as care use rebounded," they added.

Michael Wechsler, MD, MMSc, of National Jewish Health in Denver, Colorado, agreed that protection measures taken during the pandemic, such as social distancing, played a role in the decreases observed.

"During the pandemic, because of increasing isolation, asthma exacerbation rates went down globally because people weren't exposed to the same degree of viruses," he told MedPage Today. "And people were taking greater precautions. So, during the pandemic, rates went down, the incidence of exacerbations went down significantly."

Gaffney and colleagues noted that understanding the existing disparities and providing care based on that understanding could help address disparities even outside the framework of the COVID-19 pandemic.

"The narrowing asthma morbidity disparities through the pandemic suggest opportunities for mitigation, for example, improving environmental conditions or developing and equitably delivering vaccines against respiratory pathogens," they wrote. "However, other policies are needed to address the multitude of factors that drive both asthma pathogenesis and exacerbations."

Wechsler said the major takeaways from the study include the need to "continue to invest in education and the development of novel therapies and novel strategies. And I think we also need to work with communities and [have] better engagement with minority communities to appreciate the nuances of diseases like asthma -- which have significant interactions between the environment, education -- and there are clearly ways to prevent disease worsening if we can get to people."

Elizabeth Short is a staff writer for MedPage Today. She often covers pulmonology and allergy & immunology. Follow

Disclosures

Gaffney is a former president of Physicians for a National Health Program (PNHP), a non-profit organization that favors coverage expansion through a single payer program. Gaffney's spouse is an employee of Treatment Action Group, a non-profit research and policy think tank focused on HIV, TB, and Hepatitis C treatment.

Co-authors were also part of PNHP.

Primary Source

Annals of Internal Medicine

Source Reference: Gaffney A, et al "Asthma disparities in the United States narrowed during the COVID-19 pandemic: findings from a national survey, 2019 to 2022" Ann Intern Med 2023; DOI: 10.7326/M23-2100.

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Medical Moment: Preventing Obesity By Targeting A Patient's Genes

SOUTH BEND, Ind. (WNDU) - More than 40% of Americans are living with obesity.

That means they're a step above being overweight and face an increased risk for several diseases, such as heart disease, diabetes, and even asthma.

Now, researchers are learning more about what causes this health hazard and how to potentially prevent it. While lifestyle habits are a large part in the development of obesity, researchers are finding there may be more to the story.

"It is true that environment, and that includes diet and exercise, are major factors," said Dr. Eyleen O'Rourke, a professor of genomics. "However, our genes also play an important role."

University of Virginia scientists recently discovered 14 genes that can cause weight gain and three that can prevent it. They believe that these findings will one day lead to treatments that can target the genes and prevent obesity. But having the obesity genes doesn't mean you are doomed.

"The genes only make you more likely to develop the disease or less likely," O'Rourke explained.

A healthy diet and regular physical activity are still the best ways to prevent obesity. Experts say even small changes can add up. Replacing a daily sugary drink with water can cut 150 extra calories a day, which equals 10 pounds a year! And exercising 10 minutes three times a day can give you that 30 recommended minutes without seeming daunting. Limiting sit time is another strategy. If you work at a desk, set a reminder to get up every 30 minutes. Lastly, get enough sleep. Seven to eight hours a night reduces your risk of weight gain.

Studies show obesity also affects your wallet. Medical costs for people with obesity in the U.S. Are about 30% to 40% higher than those for people without obesity. So slimming down can help save your life and your savings.

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