Asthma Diagnosis Barriers for People of Color

Asthma is a chronic condition that impacts the airways of the lungs, making it difficult to breathe. If asthma isn't diagnosed and treated, it can cause serious and potentially life-threatening complications.

While statistics show that people from Black, Latinx, and Indigenous communities are more likely to develop asthma, they may also experience unnecessary delays in being diagnosed and treated. There are many reasons for these barriers, including issues related to accessing care and medication costs.

This article discusses the many obstacles that people of color often face in receiving a diagnosis and treatment for asthma.

Asthma Diagnosis Statistics and Race Disparities

When asthma is diagnosed early, it can be treated properly with medications like inhaled corticosteroids, which can lead to better long-term health outcomes. Without a diagnosis, appropriate treatment and care can't be accessed.

Children who receive a delayed asthma diagnosis are much more likely to seek treatment at an urgent care center compared to those who receive a timely diagnosis.

While global scientific research on asthma has traditionally been focused on White populations, some studies, especially more recent ones, have demonstrated the barriers that people of color face in asthma diagnosis and treatment. For example:

• Asthma-related emergency room and urgent care visits are higher in Black and Latinx children than in White children.
• According to one study, roughly 20% of Black, Latinx, and Asian American adolescents living in urban areas who reported having asthma-like symptoms did not receive an asthma diagnosis.

What Are Some Barriers to Diagnosis?

People of color in the United States face disparities in access to health care, the quality of care they receive, and outcomes. In general, they're likely to face longer delays in getting a diagnosis and receive significantly different levels of treatment for various medical conditions compared to White patients.

A variety of socioeconomic, structural, and behavioral factors have been linked to the barriers that people of color face in receiving medical diagnoses.

Access to Care and Health Insurance

Many patients of color may not be able to get an asthma diagnosis because they don't have access to a healthcare provider or health insurance, making it difficult to receive necessary medical care.

Examples of this include:

• If a person doesn't have reliable transportation to a healthcare provider's office
• If a person is unable to take time off of work for an appointment
• If there are no asthma specialists in their area
  

Research has found many issues related to access to care that serve as major barriers to a timely medical diagnosis.

One study discovered that the lack of a regular healthcare provider or specialist affected asthma treatment options for children of color. It found that, compared to their White peers, Latinx children are more likely to receive urgent asthma care at community health centers, and Black children are more likely to receive asthma care at emergency rooms.

Medication and Testing Costs

Just like other health conditions that require specialty care, the cost of managing asthma is a burden for many families, even those who have health insurance or use patient assistance programs.

Income inequality disproportionately impacts Black and Latinx communities, particularly those living in urban communities, which affects their ability to afford the copays needed to fill asthma prescription medications.

In addition, transportation and childcare expenses associated with getting to the pharmacy can add up quickly.

Family/Cultural Dynamics and Knowledge

Culturally competent care—generally defined as the ability of a healthcare provider to meet the social, cultural, and linguistic needs of a patient—can lead to timely diagnoses and better treatment.

Patients of color are likely to have cultural differences from White populations, which healthcare providers should take into consideration before an asthma diagnosis. Some of these dynamics and beliefs include:

• Higher levels of distrust in the U.S. healthcare system: Patients of color are more likely to report physician or healthcare setting mistrust due to a longstanding history of exploitative clinical research and mistreatment in the United States. This can make it difficult to connect with a consistent healthcare provider and receive an asthma diagnosis.
• Familial or cultural beliefs about medicine and preferred treatment patterns: As one study found, asthma patients with caregivers who were born abroad may not be accustomed to getting preventive management care for conditions like asthma.
• Language proficiency, literacy, and communication differences: Historically, the U.S. healthcare system has been largely unaccommodating of language or cultural differences. This results in lower medical diagnosis rates for patients with limited English proficiency. As one older study uncovered, a common reason for a delayed asthma diagnosis was the healthcare providers' lack of attention to the patients' communication about symptom history.

Risks of Misdiagnosis

If left untreated or misdiagnosed, asthma can lead to serious health complications and a higher risk of hospitalization. Some of these risks include:

• Obstructive sleep apnea
• Chronic lung inflammation
• Permanent structural changes in the airways of the lungs
• Anxiety or depression
• Complications from pneumonia, the flu, or other respiratory infections

If asthma is severe and has not been diagnosed or properly treated, an attack can lead to respiratory failure (when your lungs can’t get enough oxygen into your bloodstream), which can be fatal.

Equitable Care for People With Asthma

Equitable care means that a person’s racial or ethnic background, socioeconomic status, or other circumstances do not impact their chances of attaining high quality health care and health outcomes.

Where to Go

When looking for assistance with asthma care, start with your local health department or trusted community health organization. They should be equipped to provide you with a referral for accessible care.

Next, remember that healthcare providers (whether or not they provide direct care for asthma) are there to help you manage your asthma and overall health. It’s worth asking if the office or healthcare system has additional staff dedicated to helping you better understand your asthma treatment plan or answering questions like how to best use your asthma medications.

Financial Assistance

Asthma medications and care can be very expensive, even if you have health insurance. Healthcare providers are well aware of this, so you shouldn’t feel shy about informing them if you can’t pay for drugs or care. Your provider wants you to take your medication so that you feel better, and they may know of a program or contact to help assist you with the cost.

Some financial assistance options include:

• Checking with a clinical social worker: If you feel comfortable, your healthcare provider can give you a referral to the social worker that serves in their office who can help provide access to grants and other programs for assistance with healthcare needs.
• Using a prescription assistance program (PAP) or copay assistance program (CAP): Pharmaceutical companies offer PAPs to help cut down on drug costs and increase access to asthma medications by providing inhalers and other drugs free of charge or highly discounted to lower-income individuals and families. Alternatively, CAPs cover a portion of drug copay costs for people who have health insurance.
• Seek assistance with organizations like the Partnership for Prescription Assistance: This free online database outlines thousands of medications available at a reduced or no-cost price and helps patients determine eligibility or apply for assistance.

Advocacy and Outreach Programs

Getting help when you need it is important for managing asthma, whether that assistance is via friends, family, or a healthcare team. But not everyone has direct access to that support. Fortunately, there are nationwide organizations that exist to support people with asthma, inclusive of people from all backgrounds and communities.

To start, you may be interested in looking into the following groups:

• The Asthma and Allergy Foundation of America has a patient group that supports people with asthma through advocacy, education, and research.
• The American Lung Association’s Better Breathers Clubs offers in-person and online patient support groups so that you can connect with other people and families coping with asthma.
• The Allergy & Asthma Network, through its Not One More Life Trusted Messengers Program, offers asthma screenings geared toward communities of color in cities across the United States, with resources available in English and Spanish and a focus on training healthcare professionals to provide equitable asthma outreach care.

Summary

People of color face multiple barriers in receiving an asthma diagnosis and treatment when compared to White populations. For people of color, the likelihood of visiting an emergency room for an asthma episode and experiencing severe or fatal complications from asthma is much higher than it is in White patients, partly due to misdiagnosis or delayed diagnosis.

Research shows that factors like a lack of accessible medical care, disparities in health insurance, high medication costs, and familial or cultural dynamics play a role in creating obstacles to asthma diagnosis and treatment.

A Word From Verywell

Dealing with a chronic health condition like asthma is stressful, especially when there are unnecessary barriers to receiving a diagnosis. While getting a diagnosis for yourself or a family member is just the first step, it's an essential part of the process. Don't be afraid to lean on an extended support network of friends, family, community members, and support groups for extra encouragement along the way.