Asthma is one of the most common long-term conditions in children and affects around 4.9 million children in the United States. This means about 3 out of 30 children in an average classroom suffer from asthma. When it comes to asthma in Black children, the statistics are even higher. They are 60 percent more likely to have the condition, and more than 4 times more likely to die from it.
Because Black children already face disparities within the medical system, providers need to educate and support families managing this condition. This includes improving health literacy, removing race-based algorithms, and increasing community outreach — all of which can help close the gaps in diagnoses and treatment outcomes.
A JAMA Network study found Black children are not only more likely to have asthma, but they are also frequently misdiagnosed or underdiagnosed for the condition.
Michael Lenoir, MD, an award-winning, board-certified allergist and pediatrician, says that there are several reasons for misdiagnosis or delayed diagnoses, including “human mistakes, communication breakdowns, and systemic issues.”
“Many of these issues arise because of unconscious bias on the part of both providers and systems, who often act like Black children don’t need the time during appointments, proper evaluation (especially for allergic triggers), and the same advanced medications to fit situational symptoms as other children,” Dr. Lenoir told BlackDoctor Pro. “These factors have the same impact on asthma outcomes, and they do on all chronic diseases that affect Black Americans.”
Dr. Lenoir emphasized the impact of systemic racism, medical mistrust, and socioeconomic barriers on a Black child’s ability to receive a proper diagnosis.
“Urban Black children often rely on emergency rooms due to limited access to asthma specialists,” Dr. Lenoir said. “Black patients are less likely to receive written Asthma Action Plans or thorough medication reviews.”
Asthma can originate from genetic, immune system, or environmental factors, like a family history of the condition or exposure to secondhand smoke. Children raised in an environment with air pollution, as well as children who are overweight, are more likely to suffer from asthma.
Dr. Lenoir said the most common asthma symptom is a cough. Other common symptoms of the condition include:
Children with asthma can also experience unrecognized or misunderstood symptoms of asthma, including a chronic dry cough and rapid breathing. Recurring bronchitis or pneumonia can also be signs of underlying asthma.
“Caregivers may miss early attack signs or underestimate asthma severity,” Dr. Lenoir said. “Most children who die from asthma have mild to moderate symptoms but are not prepared for emergencies.”
Many children with asthma end up missing multiple school days, and early treatment can help decrease this instance. Early diagnosis and treatment can not only help reduce flare-ups but also protect a child’s lungs over time.
In addition to providing crisis care and emergency treatment for asthma attacks, providers should prioritize patient education on overall asthma control. This includes avoiding triggers, using medication, managing symptoms, and implementing asthma action plans, the latter of which provides your patient with information and guidance for their individual case.
One of the most important aspects of asthma control is monitoring symptoms for worsening conditions. Families with asthma should also note any life disturbances, such as nighttime symptoms, school absences, and any activity limitations.
Dr. Lenoir also suggested implementing more asthma education in children’s schools, noting providers can “use school-based asthma programs and nurse coordinators to boost medication adherence and cut ER visits.”
Black patients face disparities and obstacles in the healthcare system, and this includes medication access. This can be due to multiple factors, including high medication costs, pharmacy deserts, and mistrust of medical professionals. Insurance limitations may also make it hard for some Black families to seek out medical help for an asthma attack.
“Black patients often face limited access to quality healthcare due to being uninsured or underinsured,” Dr. Lenoir said.
Providers should also take the time to explain the differences between rescue and controller medications to Black families. While controller medications, such as inhaled corticosteroids, manage daily symptoms, rescue medications are quick-relieving for asthma attacks. Providers should set aside time to demonstrate proper inhaler and spacer use and to recheck the patient’s technique at every visit.
According to Dr. Lenoir, there are two important steps families can take to reduce triggers for asthma in Black children: reduce dust exposure and avoid any foods that could cause symptoms.
He emphasized the idea that a family’s indoor space can be a trigger in itself. “Poor housing conditions with mold, pests, and pollution worsen asthma, even with medication.”
Families of children with asthma should be educated on potential home triggers of their child’s condition, which can include pets, dust mites, chemical fumes, and tobacco smoke. To improve the child’s condition, families may need to take steps such as using dustproof covers on furniture, applying pesticides, removing pets, vacuuming regularly, and deep-cleaning washable toys.
When Black families and children have action plans and are knowledgeable about home triggers for asthma, they can better manage symptoms, seek out treatment, and get potentially life-saving medication. Clinicians must prioritize early diagnoses, provide education on effective controller management, and support caregivers. This condition is best addressed proactively rather than reactively.
Dr. Lenoir stressed the importance of providers helping to remove preventable barriers, like medication access and a lack of health education, to address asthma in Black children.
“Physicians can address disparities in asthma care by removing race-based clinical algorithms, like race adjustments in spirometry tests, to ensure accurate diagnoses,” Dr. Lenoir said. “Key actions include school-based programs, home visits to manage allergens, and case managers to support medication adherence. We know that community outreach workers for families with children with asthma reduce both morbidity and mortality.”
To help improve the research on asthma in Black children, families are encouraged to participate in clinical trials.
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