A years-long asthma trial led by a University of South Florida researcher could point a way forward in closing the disease’s historic racial gaps, according to results published Saturday by the New England Journal of Medicine.
The study, which tracked about 1,200 Black and Latino asthma patients for more than a year, focused on a promising tactic: Those who added an as-needed inhaled corticosteroid, an anti-inflammatory drug, plus whatever their doctor had already prescribed, fared better than those who continued with their usual regimen.
According to the study, minimal use of the added medication — just over one inhaler per year, on average — led to fewer severe asthma symptoms, better quality of life and fewer sick days.
The results are meaningful in part because previous efforts to address racial health disparities among asthma patients have been largely unsuccessful, said Juan Carlos Cardet, an allergist-immunologist and USF assistant professor who was the study’s lead author. The study, which involved patients from around the U.S. and Puerto Rico, listed nearly 50 co-authors.
“The fact that we had a positive outcome … something that could improve the lives of people, it’s a privilege,” Cardet said of the study, which took eight years to complete.
Black Americans die of asthma at more than double the rate of white Americans, according to the Centers for Disease Control and Prevention. They’re also about five times as likely to visit the emergency room or be hospitalized due to the disease. In Florida, emergency room visits, hospitalizations and deaths from asthma all happen at triple the rate for Black residents compared to white ones, according to Department of Health data.
In Pinellas County in 2020, the disparities in emergency room and hospitalization rates were even wider, though the county’s disparity in death rates was less stark than the state average. Overall, Tampa Bay is among the worst regions in the state when it comes to asthma-related hospitalizations of Black people, with above-average rates in Pinellas, Hillsborough, Pasco, Hernando, Polk and Manatee counties.
Cardet’s research honed in on how patients treat their asthma. Asthma regimens generally fall into two buckets, he said: There’s rescue medication — think a “use-as-needed” inhaler. Then there’s controller or maintenance medication, which requires regular, frequent use. The latter has been associated with lower mortality rates, Cardet said, but research has shown that Black patients use controller medication much less often than white patients. Cardet and previous research have suggested numerous reasons for this, including barriers in access to specialists, differences in patients’ communications with doctors and disparities in health insurance.
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In a process that Cardet said was “unseen in the pharmaceutical industry,” a group of patients collaborated with researchers on the design of the trial. They vetted the researchers’ language, helping to make it more understandable to average patients, adding new angles to the monthly surveys participants would answer, and developing a system for personalizing them. Cardet said researchers found that patients rarely used technical terms like “rescue therapy”; instead, they might color-code their inhalers, or give them nicknames, like “Bob” or “friend.”
“In a substantial portion of cases, there’s miscommunication,” he said. “That mismatch in terminology, after controlling for 15 different variables, actually creates worse outcomes.”
By stripping away the jargon — and giving patients the option to respond to surveys by mail, over the phone or online — Cardet said the researchers got more engagement from participants and more accurate responses.
The next steps involve incorporating the trial results into clinical practice, Cardet said.
“It’s actually a big decrease in asthma exacerbations and asthma morbidity in the health care system achieved by one inhaler per year per person,” he said.