Racial Differences in Asthma Inhaler Use Raise Questions About Equity in Care

Asthma is a chronic respiratory condition that affects nearly 28 million Americans. Despite the prevalence of the condition, Black adults are disproportionately affected by asthma. They are nearly six times more likely than white people to visit the emergency department for asthma complications. Systemic inequities, environmental racism, and limited healthcare access all contribute to these asthma disparities.

In a research letter published in the Journal of the American Medical Association, investigators identified racial and ethnic differences in asthma inhaler use among U.S. adults, underscoring persistent gaps in asthma management.

What the Study Found

Jing Ren, M.D., from the David Geffen School of Medicine at UCLA in Los Angeles, and colleagues examined how demographic, socioeconomic, clinical, and health care access factors may contribute to observed differences in inhaler use using pooled Medical Expenditure Panel Survey data from 2014 to 2023 for U.S. adults who reported medical care for asthma.

A total of 10,516 adults with asthma were identified, with notable variation in sociodemographic and health care utilization factors by race and ethnicity. The researchers found that compared with other racial and ethnic groups, a greater proportion of white adults utilized inhaled corticosteroid (ICS), long-acting β-agonist (LABA), and long-acting muscarinic antagonist (LAMA) inhalers, and fewer reported short-acting β-agonist use. 

After adjustment for socioeconomic and health care access, lower probabilities of ICS use among Black adults and lower probabilities of LABA use among Black and Hispanic adults were attenuated. The probabilities of ICS and LABA use remained lower among Asian than white adults after full adjustment, as did the probabilities of LAMA use among Black and Hispanic adults compared with white adults.

“These findings highlight the need for multilevel, equity-informed interventions to improve asthma care. Addressing the root causes of structural determinants of health remains essential, but strategies such as ensuring affordable drug pricing and expanding access to specialty care may improve asthma management in the near term,” the authors write.

Could Access and Affordability Influence Asthma Inhaler Use?

Insurance formularies often determine which inhalers patients can access. When medications have higher out-of-pocket costs, patients may be unable to afford them, leading to reduced adherence. Prior authorization requirements can also delay the initiation of guideline-directed therapies. 

Socioeconomic factors, including transportation challenges and pharmacy deserts, may further complicate access to both initial prescriptions and refills, particularly for Black patients.

Asking patients whether they have been able to obtain and consistently use prescribed inhalers can uncover barriers that spirometry alone will not reveal.

From our partner

Vitiligo doesn’t have to keep you down - Find out how the FPAD clinical trial may help!

Don’t Assume Nonadherence

For clinicians, delivering culturally responsive care is critical to improving treatment adherence — especially among Black patients. Rather than assuming nonadherence, providers should seek to understand the reasons behind inconsistent asthma inhaler use. Some patients may stretch inhaler use, skip doses, or rely on rescue medications due to cost concerns. Historical mistrust and communication gaps may also influence treatment decisions within Black communities. 

Open-ended questions, such as “What challenges have you had using this medication?”, often yield more actionable information than asking whether they are compliant.

Practical Steps for Clinicians

Here are several practical strategies clinicians can implement to support asthma medication adherence among Black patients:

• Review inhaler technique at every visit
• Assess medication affordability and insurance coverage
• Screen for social determinants affecting asthma management
• Consider referral to asthma educators or community health workers
• Monitor rescue inhaler refill frequency as a marker of poor control
• Reassess whether treatment aligns with current guideline recommendations

The Takeaway

Although the study cannot explain why inhaler use differs across racial and ethnic groups, it reinforces an important reality: equitable asthma management extends beyond writing a prescription. For Black patients, factors such as medication affordability, pharmacy deserts, environmental exposures, and trust in the healthcare system can all shape whether evidence-based treatments are used consistently and effectively. By assessing these barriers and engaging patients in shared decision-making, clinicians can help close persistent gaps in asthma outcomes.

Abstract/Full Text (subscription or payment may be required)

Are you a healthcare professional? Register with us today!