Asthma is one of the most common chronic diseases in the U.S., affecting more than 27 million people. While up to 75% of people with asthma have mild disease, it can affect quality of life and may be deadly if it’s not well-controlled. The burden of asthma is greater for some communities. Black, Hispanic, American Indian, and Alaska Native populations have higher rates of asthma. Higher rates are seen in people in low-income communities as well.

Asthma During the COVID-19 Pandemic

The early lockdown period of the COVID-19 pandemic brought a surprising period of relief for many people with asthma. Asthma attacks declined. Some people reported easier breathing.

In May 2021, the Asthma and Allergy Foundation of America (AAFA) and Komodo Health published a research brief that further measured the impact of COVID-19 lockdowns. The project focused on race-based disparities in asthma-related emergency department visits. It compared emergency department rates in cities with high numbers of Black residents to cities with low numbers of Black residents.

The analysis found that while the total number of emergency department visits went down, race-based gaps grew. People living in cities with the highest number of Black residents were more likely to visit an emergency department with an asthma-related illness than people in cities with the lowest number of Black residents. The differences were stark.

For example, in New Orleans (60% Black population), about one in three residents with asthma visited the emergency department for a related condition at least once in 2020. This compares to only about one in 10 in Salt Lake City, where only 3% of the population is Black.

Asthma Since the Height of the COVID-19 Pandemic

Overall, asthma prevalence in the United States increased in 2022. More than 27 million people in the U.S. have asthma.

In a new analysis, we wanted to understand how race-based asthma disparities changed since the height of the COVID-19 pandemic. We looked at cities with the highest and lowest numbers of Black residents in 2022. Within these cities, we looked at severe asthma, emergency department visits, and prescriptions for quick-relief medicine.

Here’s what the new analysis found:

1. People with asthma in cities with the highest number of Black residents were slightly more likely to have severe asthma compared to those in cities with the lowest number of Black residents.
   
   In the six cities with the highest number of Black residents, 3.1% of people with asthma had severe asthma. This compares with 2.7% of people with asthma in cities with the lowest number of Black residents.
   
   
2. In 2022, roughly half of New Orleans residents with asthma visited the emergency department for an asthma-related illness.
   
   People with asthma living in cities with the highest number of Black residents were 9% more likely to visit the emergency department in 2022 (40% vs. 31%). Of the cities included in this analysis, New Orleans (60% Black population) had the highest rate of emergency department visits. Half (49%) of the people with asthma in New Orleans visited the emergency department for a related illness in 2022. Portland (6% Black population) had the lowest rate at 25%.
   
   
   
   Differences in emergency department visits were much larger than those in asthma severity. This may be a result of social and structural determinants of health that can lead to an overreliance on emergency care. These include differences in insurance, care, and medicine access.
   
   

3. The prescription rate for quick-relief drugs was 6% higher in cities with the highest numbers of Black residents. This includes both oral corticosteroids and non-steroidal medicines.
   
   In 2022, 68% of people with asthma in cities with the highest number of Black residents had a prescription for a quick-relief drug. In cities with the lowest number, 62% of people with asthma received quick-relief prescriptions.
   
   The difference in prescription rates was higher for steroidal drugs (7% higher) than non-steroidal drugs (5% higher). Oral corticosteroids (such as prednisone) may be prescribed to treat asthma attacks when a person hasn’t responded to other asthma medicines. Higher steroid medicine use may result from more severe or uncontrolled asthma.
   
   

Conclusion

Racial and ethnic disparities exist across most areas of health and health care. As in the case of asthma, socioeconomic and environmental inequities drive these disparities. The overall risk from these overlapping inequities makes asthma disparities greater.

The COVID-19 pandemic has highlighted the stark inequities that exist in the U.S. health care system. Health equity continues to be a focus now and will also be after the pandemic. Evidence based on data is key as we move to explain population-wide health disparities.

Data are also key to inform policy changes that address race- and ethnicity-based gaps in exposure, health, and care. This is particularly important for asthma. Disparities continue despite general improvement in asthma outcomes over the past 20 years. Population-based studies are critical to developing public health programs and improving asthma outcomes.

Methodology

This analysis looked at cities with the highest and lowest proportions of Black residents in 2022. We used ICD-10-CM codes to identify patients with:

• Severe asthma
• Asthma and one or more ED visits
• Asthma and a prescription for a quick-relief steroid medication
  
  

We then stratified the data by ZIP code using U.S. census data, grouping cities with a >40% Black population and a <10% Black population.

The cities with the highest proportions of Black residents were: Atlanta, Cleveland, Detroit, Memphis, New Orleans, and Washington, D.C.

The cities with the lowest proportions of Black residents were: Austin, Phoenix, Portland, Salt Lake City, San Diego, and Seattle.

About Komodo Health

Komodo Health is a technology platform company creating the new standard for real-world data and analytics. Komodo pairs the industry’s most complete view of patient encounters with enterprise software and machine learning to connect the dots between individual patient journeys and large-scale health outcomes. Across Life Sciences, payers, providers, and developers, Komodo helps its customers unearth patient-centric insights at scale. The company marries clinical data with advanced algorithms and AI-powered software solutions to inform decision-making, close gaps in care, address disease burden, and help enterprises create a more cost-effective, equitable, and value-driven healthcare system. For more information, visit komodohealth.com.

This content was adapted from content published by AAFA and Komodo. Race-Based Disparities in Asthma: A Post-Pandemic Snapshot © 2023 Komodo Health, Inc. All rights reserved. Reproduction, distribution, transmission or publication is prohibited. Reprinted with permission.

Welcome to our September research update! Getting involved with research is an important way to impact asthma and allergy treatments, education, and awareness.

This month, we are highlighting clinical trials, interviews, focus groups, and news on:

• Asthma
• Hypereosinophilic syndrome (HES)
• Chronic spontaneous urticaria (CSU)
• Universal flu vaccine clinical trial
• EGPA clinical trial results
  
  
  

Latest Asthma and Allergy Research News

Asthma

AAFA’s 2023 Asthma Capitals™ Report Lists Most Challenging Cities to Live in the U.S. with Asthma
Asthma is greatly influenced by where someone lives. People who have affordable and accessible health care, clean air, and economic stability have a greater chance of managing and controlling their asthma. AAFA’s Asthma Capitals™ report ranks the largest 100 cities in the continental U.S. by how challenging they are to live in when you have asthma. AAFA publishes this report to show the nationwide burden of asthma. It is a call to action to help the more than 27 million people in the U.S. with asthma.

Asthma-Associated Emergency Department Visits During the Canadian Wildfire Smoke Episodes — United States, April–August 2023
From April 30 to Aug. 4, 2023, smoke from wildfires in Canada affected most of the contiguous United States. A new report from the Centers for Disease Control and Prevention (CDC) shows that asthma-associated emergency department visits were 17% higher than expected during the 19 days with wildfire smoke that occurred during the study period. Larger increases were seen in regions that had higher numbers of continuous wildfire smoke days and among children aged 5 to 17 and adults 18 to 64 years. These results can help guide emergency response planning and public health communication strategies, especially in U.S. areas where wildfire smoke exposure was previously uncommon.

Pollen-Related Asthma More Likely to Land Black Patients in the Hospital, Study Finds
Climate change has long been associated with longer and more intense pollen seasons. In a new study, researchers in Atlanta looked at how pollen affected asthma in the city over a 26-year timeframe. The study results were similar to previous research suggesting that pollen seasons are starting earlier, lasting longer, and becoming more intense. But the study also uncovered racial disparities in emergency department visits. Black patients were twice as likely as white patients to visit the emergency department for allergic asthma. This might be due to where they live, access to health care, and disparities in asthma treatment quality.

Food Allergy

AAFA Releases Statement on FDA Decision on neffy® Epinephrine Nasal Spray
On Sept. 19, the FDA rejected neffy, an epinephrine nasal spray to treat anaphylaxis, a severe allergic reaction. The FDA has asked for another study. The Asthma and Allergy Foundation of America (AAFA) released a statement about the FDA’s decision.

New Stock Epinephrine and Stock Inhaler Toolkits Improve Safety of Students with Anaphylaxis and Asthma
The American Academy of Allergy, Asthma & Immunology (AAAAI) has created new stock epinephrine and stock inhaler toolkits to help schools keep kids safe. The toolkits are designed to work in different states and schools to help prevent dangerous asthma and allergy emergencies and keep students safe. The epinephrine toolkit has information on what to do during a severe allergic reaction, training for non-medical staff, and videos to help students with allergies. The inhaler toolkit has resources on understanding state laws, how to help students having trouble breathing, and how to train staff.

Nestlé Divests Peanut Allergy Treatment Palforzia to Stallergenes Greer
Nestlé has sold its peanut allergy drug, Palforzia, to Stallergenes Greer, a Swiss biopharma company. Palforzia is an oral therapy that helps reduce peanut allergies by gradually exposing patients to small amounts of allergenic proteins. It was approved for children aged 4 to 17 and adults following a peanut-avoidant diet. This will expand Stallergenes Greer’s portfolio, which already has treatments for various allergies like grasses, mites, and trees.

Nasus Pharma Announces Publication of Positive Clinical Results for Its Epinephrine Intranasal Powder Spray
Nasus Pharma has shared positive findings from a study on their new epinephrine intranasal powder-based spray. This device, called FMXIN002, aims to provide quick and effective relief for severe allergic reactions caused by food, medicine, or insect bites. The study compared it to traditional epinephrine auto-injectors that deliver medicine through the muscle. The study found that FMXIN002 performed well, especially in simulating nasal congestion during allergic reactions. It delivered epinephrine quickly and effectively, with no significant side effects. This powder-based approach also offers better stability and longer shelf life compared to liquid forms of epinephrine. These results suggest that the new intranasal powder could be a promising and user-friendly solution for life-threatening allergies.

Flu

NIH Clinical Trial of Universal Flu Vaccine Candidate Begins
A clinical trial for a new universal flu vaccine has started at the National Institutes of Health's Clinical Center. Current flu vaccines are updated each year to best match the three to four strains of flu that are predicted to be the most dominant in the upcoming flu season. This new vaccine, called FluMos-v2, aims to provide broader protection by displaying harmless flu proteins on small particles. This method trains the immune system to recognize and fight the actual flu virus. The trial will involve 24 healthy volunteers receiving two shots of the vaccine 16 weeks apart. Researchers hope it will offer protection against various flu viruses. If successful, such vaccines could be taken less often and safeguard against multiple flu strains.

Eosinophilic Granulomatosis with Polyangiitis (EGPA)

FASENRA Met the Primary Endpoint in the Mandara Phase III Trial in Eosinophilic Granulomatosis with Polyangiitis (EGPA)
AstraZeneca's FASENRA (benralizumab) has shown positive results in a phase III trial for treating eosinophilic granulomatosis with polyangiitis (EGPA). EGPA is a rare, immune-related disease that can damage various organs if left untreated. FASENRA is a monthly injection that targets eosinophils, white blood cells involved in inflammation. The trial compared FASENRA to mepolizumab, the only approved treatment for EGPA. FASENRA demonstrated similar remission rates and was shown to be safe to use. These results are promising as there are limited treatment options for EGPA patients. FASENRA's convenience and effectiveness could make it a valuable treatment for EGPA, improving the lives of those affected.

The Food and Drug Administration (FDA) requested another study on neffy®, a epinephrine nasal spray to treat anaphylaxis, a severe allergic reaction. This will delay approval of neffy by at least a year.

The FDA Pulmonary-Allergy Drugs Advisory Committee (PADAC) voted on May 11 to recommend the approval of neffy for both adults and children over age 6. On Sept. 19, the FDA delayed approval and asked for a study on neffy in people with allergic rhinitis.

If you or your child is at risk for anaphylaxis and has a fear of needles, there are ways you can become more comfortable with injecting epinephrine.

Practice using your epinephrine auto-injector trainer to help you and your child become more comfortable with the process. This will help you understand how the auto-injector works. Follow the instructions for your device and push the trainer against your thigh. After you hear a click, hold the device for a few seconds (you only need hold most devices for two or three seconds). If you have expired epinephrine injectors, you can practice using them on an orange or a grapefruit.

Remember that for many auto-injectors, you won’t see the needle at all. After you press the device on your thigh, a needle will release. Once you remove the device, that needle will likely retract back into the device.

Ask your doctor for an Anaphylaxis Action Plan. This will outline how to recognize symptoms of anaphylaxis and help you feel more confident about when to use your epinephrine.

Talk with your doctor about any concerns you have about using epinephrine. Epinephrine is safe and effective. Your doctor can answer your questions and address any concerns you have about using it.

A Food and Drug Administration (FDA) advisory committee held a meeting on Sept. 11-12 to decide if the drug phenylephrine should continue to be sold as a treatment for nasal decongestion. This drug is found in many cold and allergy medicines.

The committee voted that the data demonstrate that oral versions of phenylephrine are not effective. The FDA will now decide whether or not it will continue to allow the medicine to be sold in oral formulations to treat nasal congestion.

This is important for people with nasal allergies (allergic rhinitis, or “hay fever”) because this could affect the medicines easily available as part of allergy treatment.

What Is Phenylephrine?

Phenylephrine is a medicine you can buy over the counter (OTC) for nasal congestion caused by allergic rhinitis or the common cold. It is sold by itself or in combination medicines that treat cold, flu, and allergy symptoms.

Medicines that contain phenylephrine include:

• Tablets
• Liquid
• Eye drops
• Nasal sprays
  
  

Some examples of medicines that contain oral phenylephrine include SUDAFED® PE, Mucinex® SINUS-MAX®, and Benadryl Allergy Plus Congestion.

Why Is the FDA Reviewing Oral Phenylephrine for Nasal Congestion?

The FDA is reviewing the use of oral phenylephrine because there is a concern that it is not effective as a nasal decongestant. The medicine has been around since the 1970s. Many of the older studies done on the drug were not sound or used older methods. Newer studies do not show oral phenylephrine to be effective as a nasal decongestant.

The FDA is only reviewing the oral versions (liquid and tablets) and not nasal sprays and eye drops. Versions used to treat other conditions will not be affected by this vote.

In fact, data do demonstrate that nasal sprays with phenylephrine are effective at reducing nasal congestion. But they should not be used for more than three days at a time. Continued use of nasal phenylephrine can lead to “rebound” phenomenon. This is a situation where stopping the medicine could lead to worsening symptoms, as well as the fact that more medicine is needed to achieve the same level of decongestant effect.

What Happens If the FDA Reclassifies Oral Phenylephrine?

If the FDA reclassifies oral phenylephrine, the drug will no longer be sold as a nasal decongestant. That means many popular OTC oral cold and allergy medicines will no longer be sold.

This may be concerning for people with nasal allergies. Nasal decongestants, used for a short time period, can be part of a treatment plan for allergic rhinitis and colds.

If you currently rely on an oral medicine that contains phenylephrine, talk with your doctor about other more effective treatment options. (And remember, decongestants should only be used for one to three days.)

Can a Nasal Corticosteroid Spray Help My Nasal Congestion?

A nasal corticosteroid spray is a safer option for treating your nasal congestion. They work by reducing inflammation (swelling) in your nose and block allergic reactions. (Examples include Nasacort®, FLONASE®, and RHINOCORT®.)

Nasal corticosteroids work better and have fewer side effects. Unlike nasal decongestants, they are designed to be taken for a long time. Many are available over the counter. Just note that nasal steroids do not give immediate relief and may take up to a week to 10 days before having a full effect. Using them regularly keeps nasal symptoms under control.

What Other Treatments Can I Use for Nasal Congestion?

If you have nasal congestion due to allergies, you do have other options to help manage your symptoms. A combination of treatments while reducing your exposure to your allergens can help you manage your allergic rhinitis symptoms.

The first and best option to manage allergic rhinitis is to avoid contact with allergens that trigger nasal symptoms. If reducing your exposure to your allergens isn’t enough, there are other treatment options. Many are available over the counter.

Pseudoephedrine is another OTC medicine that treats nasal congestion. But current laws make it harder to buy. It is only sold directly from pharmacies, so you have to go to a pharmacy counter to purchase it. Laws also limit how much you can buy.

If you have high blood pressure or heart disease, you may not be able to take pseudoephedrine. It may raise your blood pressure. If you have thyroid disease, glaucoma, or trouble urinating, talk with your doctor about using pseudoephedrine.

If you do not get complete relief from medicines or managing your allergen exposure, talk with an allergist about immunotherapy (allergy shots or tablets). Immunotherapy is a long-term treatment that can help prevent or reduce allergic reactions.

How do you manage your nasal allergies? Tell us in the comments below.

Medical Review: Sept. 2023 by Mitchell Grayson, MD

September is a critical month for people with asthma. During the month, asthma attacks, hospital stays, and deaths tend to be the highest. This is called Asthma Peak Month, or the September Asthma Epidemic.

Several factors that impact people with asthma all come together during September. By the time the third week of the month arrives, the number of asthma attacks is at its worst. This is known as Asthma Peak Week.

Here are the factors that lead to a spike in asthma attacks in September and what you need to know about them.

A New School Year

Children may be affected the most by Asthma Peak Month. When kids start a new school year, they are exposed to a lot of asthma triggers. They are exposed to respiratory illnesses, allergens, and poor indoor air quality in school buildings.

Children start school as respiratory illnesses start to spread. The asthma peak usually affects them first. They then bring illnesses home to their families and older adults, who may experience the asthma peak a bit later.

Indoor air quality is a serious concern in schools as well. Many school buildings are older and in poor condition. They need repair but may not have access to funds to improve their buildings. This has a major impact on children with asthma who are exposed each school day to irritants and allergens, such as mold, pests, pollen, and pet dander.

Respiratory Illnesses

Respiratory illnesses – such as the flu, COVID-19, RSV, and colds – can trigger asthma symptoms. They tend to spread more during cooler weather as we move from summer into fall.

Weed Pollen

In the U.S., weed pollen season starts in the late summer and goes through the fall. Ragweed pollen causes most of the allergy symptoms during this time. It peaks in mid-September – which happens to be around the same time as Asthma Peak Week.

If you have allergic asthma and are allergic to ragweed, ragweed pollen can cause asthma symptoms.

Mold

Mostly thanks to falling leaves that collect on the ground, mold counts tend to go up in the fall. For the West Coast states, September marks the return of the rainy season. In some parts of the South, humidity can still be high in the fall too, creating an ideal environment for mold to thrive and cause allergic asthma symptoms.

Extreme Weather and Wildfires

September can bring extreme weather as we move from summer to fall. Weather can be an asthma trigger.

Summer heat and humidity – common asthma triggers – are still around in many parts of the United States in September. Humid air can feel heavy and harder to breathe. It can also increase mold, dust mites, and ground-level ozone – common asthma triggers.

Wildfire season in the West can start in the summer and go through October. But wildfires can happen anywhere, anytime in the U.S. during dry, hot, and windy conditions. Lightning and windstorms (like hurricanes) can spark wildfires.

Wildfire smoke can travel hundreds, even thousands of miles. The smoke and pollution in the air from the fires can impact air quality. Poor air quality can worsen asthma symptoms.

September is also the peak month of hurricane season. Hurricanes can include many factors that can expose people to asthma triggers, such as:

• Mold from flooding and water damage
• High humidity
• Rain and thunderstorms
• Sudden weather changes
• Stress
• Irritants during clean-up
  
  

How to Manage Your Asthma During Asthma Peak Month

When you have asthma and are exposed to several of these triggers, conditions, and events all at once, they can have a huge impact. This is why it’s so important to follow your Asthma Action Plan and keep your asthma under control.

If your asthma is not under control or you have concerns about Asthma Peak Month, talk with your doctor. Know what to do if you have emergency asthma symptoms. And review the resources in this blog post to help you manage your asthma depending on the triggers and conditions that affect you.