Asthma

What it is

Asthma is a long-term condition in which the airways become inflamed and narrow, so breathing gets harder. About 1 in 13 people in the United States have asthma, and when symptoms worsen a person can have an asthma attack [1].

Why this guide is written for Black patients

The National Heart, Lung, and Blood Institute states that Puerto Rican people and Black or African American people have a higher risk of developing asthma than people of other racial or ethnic groups, and that Black or African American and Hispanic children are more likely than non-Hispanic white children to die from asthma [2].

The Office of Minority Health puts the whole chain in numbers. In 2024, Black adults were 14 percent more likely than US adults overall to have asthma and Black children were 60 percent more likely than US children overall [3]. In 2020, Black adults were almost three times as likely to visit an emergency department for asthma and Black children about two and a half times as likely [3]. In 2023, Black adults were twice as likely as US adults overall to die from asthma, and Black children almost four and a half times as likely [3].

Look at the shape of that. The gap in who has asthma is modest. The gap in emergency visits is large. The gap in deaths is larger still. Whatever is going wrong is happening after diagnosis, in control and in access, not in who gets the condition.

What to ask a clinician

• Do I have a written asthma action plan, and can I have a copy today?
• Which inhaler is the controller and which is the reliever, and how do I know which is which in the dark?
• Can you watch me use my inhaler, so we know the medicine is reaching my lungs?
• How often am I using the reliever, and what number tells us the control is failing?
• Should I have a spacer, and is a peak flow meter useful for me?

What good care looks like

Good asthma care is written down. An action plan sets out what to take every day, what to do when symptoms start, and the point at which you stop adjusting and go for help. If nobody has given you one, that is the first thing to ask for.

It also means the right medicine used the right way. Ask to demonstrate your technique rather than describe it, because a poorly used inhaler and no inhaler at all produce the same test results.

Triggers get named specifically. The NHLBI lists indoor and outdoor allergens, emotional stress, physical activity, infections, some medicines including aspirin, poor air quality and cold air [2]. Risk factors include allergies, obesity, occupational exposures, climate change and air pollution [2]. Pollen, exercise, viral infections and cold air can all set off or worsen symptoms [1]. Housing conditions, mold and pests are part of that conversation, and a clinician who asks about your building is doing the job properly.

Finally, good care counts reliever use. Needing the rescue inhaler more often than a couple of days a week is not a personal failure, it is data that the controller plan needs changing.

When it is urgent

Call 911 for breathing so hard that speaking in full sentences is not possible, for lips or fingertips turning blue or gray, for a reliever inhaler that is not working or is wearing off within a couple of hours, for drowsiness or confusion, or for a child whose ribs pull in with each breath.

Go the same day for symptoms waking you at night, a peak flow reading in the range your action plan calls yellow, or an attack that needed steroids in the last month.

What to do next

Start with the plan, in writing, from whoever prescribes your inhalers.

If control is not holding, or if you have already had an emergency visit, ask for a referral. See Black pulmonologists for the lungs and Black allergists if allergies or a specific trigger are driving the attacks. Take your inhalers to the appointment, in the box, so the dates can be checked.