Imagine your child happily playing outside. Now imagine her suddenly gasping for breath. In moments, you find yourself going from carefree playtime to focused caregiving. Luckily, a rescue inhaler meets the need. But this scary scenario describes a familiar experience for many families with asthma.
Decades of research make clear stark disparities in asthma prevalence, mortality, and healthcare utilization along racial and ethnic lines. Black people in the United States, for example, are 1.5 times more likely to have asthma, five times more likely to visit emergency rooms for asthma attacks, and three times more likely to die from the disease.
“A complex set of factors explains these disparities. We know the disproportionate harm from the healthcare system on underserved populations has roots in deep, systemic racism,” said Lynne G. Bosma, MSW, C-HWC, Health Equity & Outreach Program Manager at the Asthma and Allergy Foundation of American (AAFA).
“Lack of equal access to safe and healthy housing in our communities impacts both asthma control and health disparities. Air pollution also triggers asthma. Due to red-lining and decades of discriminatory community design, many individuals vulnerable to the burden of asthma live near air pollution sources like manufacturing plants and highways. More than 40 percent of the U.S. population lives in an area with unhealthy levels of air pollution.”
Another barrier is limited access to asthma specialists. “This comes back to the systemic disinvestment in communities of color. Individuals with barriers to healthcare often lack access to specialists,” explains Bosma. As long-time strategic partners, AAFA and PlatformQ Health work together to break this cycle of inequity through trusted digital education.
Bridging knowledge gaps
“Because of this limited access to asthma specialists, many families first seek asthma care through primary care clinics and community health clinics. However, an abundance of research suggests a lack of comprehensive asthma knowledge among providers in those settings,” says AAFA Public Health Manager Stacey Denham, MSW, MPH. “The more we can provide support to healthcare providers in the form of education and health literacy for their patients, the better outcomes will be for those patients walking through their door.”
AAFA’s work with PlatformQ seeks to bridge the gap in provider knowledge about this complex disease. “We encourage healthcare providers to look at asthma care through a holistic lens,” explains Denham. “The condition presents differently in each person, and what causes an asthma attack may vary greatly from person to person. Educators like AAFA encourage providers to sit down with patients to understand not only their triggers but also the environment where they live and the social factors playing a role in their ability to receive care.”
“Taking a pause and really seeing someone as an individual can be hard in a fast-paced, managed care situation,” says Bosma. “Our work challenges providers to understand individual needs and build trust while thinking creatively and finding partnerships that help address the social determinants of health.”
For example, the Wisconsin Department of Health won an EPA award for a program to creatively use Medicaid dollars to pay for home remediations that affect asthma.
Digital education for healthcare professionals
When it comes to education, the delivery mechanism matters just as much as the content. “There’s no shortage of health education about how to manage asthma, but we’re learning that how you deliver it is the most essential piece,” says Bosma. Sharing the patient journey helps us truly engage learners.
A recent continuing medical education (CME) program produced by AAFA and PlatformQ Health was available digitally to healthcare professionals as both a live program and to watch on demand. The CME program featured a panel discussion led by AAFA president and CEO Kenneth Mendez, faculty from the Herbert Wertheim School of Public Health and George Washington University, along with a video segment of a patient interview. The program drew 2,064 learners, nearly 58 percent of whom were primary care providers and seven percent were allergists, immunologists, and pulmonologists. Throughout its programs, PlatformQ Health conducts polls to gain insights from learners.
In this session, approximately half of all learners reported they believe that insurance-related barriers to moderate-to-severe asthma care are more common among their non-white patients. In addition, specialists were more likely to identify cultural or religious beliefs, difficulty with injections, or difficulty understanding the reason the medication is needed as barriers than PCPs.
The session resulted in:
- 31,927 social media engagements with the patient video
- Notable increases in competency around topics such as:
- Factors contributing to low adherence to asthma treatment
- Interventions that can lower rates of severe asthma incidents in Black and Latinx patients
Self-care a pressing need
Through its outreach efforts, AAFA identified discrepancies between self-reported well-controlled asthma and the Global Initiative for Asthma (GINA) symptom criteria, emphasizing the need for patient education. Many patients demonstrated a limited understanding of what asthma control felt like. Of patients enrolled in AAFA’s Health Equity, Advancement, and Leadership (HEAL) program in Detroit, only six percent self-reported that their asthma was not well-controlled. However, when those same patients used the AIRQ tool to measure asthma control, 55 experienced asthma not classified as well controlled. These patients faced issues that impacted their quality of life. These discrepancies emphasized the need for patient education.
To help with this knowledge gap and show what everyday quality of life can feel like with good asthma control, AAFA provides free digital education to people with asthma. AAFA also reinforces the importance of seeing asthma specialists, who have access to both pulmonary testing and the latest treatment options that might not be available in a primary care setting.
Education helps patients advocate for themselves and take steps to more effectively control their condition. “It’s been humbling to meet people in their 70s and 80s who’ve been managing asthma since childhood. After they participate in the HEAL program they experience asthma control for the first time in their life,” explains Bosma.
Home assessments
Another powerful way AAFA works with patients with asthma is through home environmental assessments. AAFA’s HEAL program focuses on groups experiencing the disproportionate burden of asthma. This includes individuals that are Black, Hispanic, and American Indian/Alaska Native. Modeled after evidence-based practices, the HEAL program offers one-on-one, in-home or virtual support for families in Chicago, New York, St. Louis, Detroit, New York City, and rural communities throughout Alabama.
In meeting patients where they are, community health workers can understand individual needs, connect families with a physician, offer in-home or virtual environmental assessments to identify asthma and allergy triggers, and more. Each visit is personalized, depending on the family’s needs. It may involve providing remediation like HEPA filters or green cleaning products, lobbying a landlord to remediate mold in the family’s home, explaining how to manage asthma daily, and/or helping patients access programs to reduce medication costs.
The program’s preliminary results show promise. The AAFA Michigan Chapter (Detroit HEAL site) reports a 150 percent increase among patients consulting pulmonologists, with a 40 percent reduction in emergency room and unplanned provider visits for asthma. Patients also self-reported enhanced asthma management knowledge and confidence, showing a 50 percent increase in overall confidence in managing their asthma after six months in the program.
Looking to the future
Building on the success of its education programs, AAFA and PlatformQ Health have extended their strategic partnership for another three years. Together, the organizations plan to advance the state of asthma education in novel ways to improve the lives of people most affected by the disease.
“PlatformQ Health really opens doors for collaborations between organizations, communities, and state health departments, allowing us to amplify our reach,” says Denham. “This gives us exposure to new avenues of delivering education.”
“Equity is the foundation of all the work we do,” says Bosma. “Together with PlatformQ Health, we’re living out our mission of being a trusted ally of the asthma and allergy community.”