Asthma in Black and African American Communities: Disparities, Causes, and Specialist Care in Broward County

Of all the racial disparities in asthma outcomes documented in the United States, the gap affecting Black and African American communities is among the most severe and persistent. Black Americans are more likely to have asthma, more likely to be hospitalized for it, and approximately three times more likely to die from it than white Americans — despite asthma being a well-understood, highly treatable condition. In Broward County, where Black residents make up approximately 29% of the population, this disparity affects hundreds of thousands of people.

This article examines the data behind these disparities, the biological and environmental factors that drive them in South Florida, the systemic barriers that stand between Black patients and optimal care, and what comprehensive specialist evaluation and treatment looks like for our Broward County community.

Prevalence and Mortality: Understanding the Full Scope

Current national data from the CDC's National Health Interview Survey reveal significant racial gaps in both asthma burden and outcomes:

Beyond mortality, Black patients experience disproportionately high rates of asthma-related emergency department visits — roughly three times that of non-Hispanic white patients. This pattern — acute crisis managed in the ER rather than chronic disease managed by a pulmonologist — is itself a marker of inadequate access to preventive specialist care.

Biological Factors: Why Asthma May Present Differently

Biological differences contribute to the disparity, though they are neither deterministic nor immutable — and they do not explain the full gap. Several pharmacogenomic and physiologic factors are relevant for Black patients and their providers:

ADRB2 Gene Polymorphism (Beta-2 Adrenergic Receptor)

The ADRB2 gene encodes the beta-2 adrenergic receptor, which is the molecular target of albuterol and other short-acting bronchodilators. A common variant at position 16 — Arg/Arg genotype — occurs at higher frequency in individuals of African descent and has been associated with reduced sustained bronchodilator response with regular albuterol use. This means that some Black patients may not receive full therapeutic benefit from albuterol alone, making controller therapy and, where indicated, biologic treatment even more critical.

Eosinophilic vs. Non-Eosinophilic Phenotypes

Studies suggest Black patients with severe asthma have higher rates of non-eosinophilic (neutrophilic or paucigranulocytic) inflammation compared to white patients. Since most approved biologics target the eosinophilic (type-2) pathway, biomarker-driven evaluation is essential to identify which patients are candidates for which therapies. This is not a reason to withhold biologic evaluation — tezepelumab (Tezspire), which targets TSLP upstream of both eosinophilic and non-eosinophilic cascades, has demonstrated efficacy regardless of baseline eosinophil count.

Lung Function Reference Values

The spirometry reference values traditionally used to classify airflow obstruction were derived predominantly from white European populations. Studies have found that applying race-specific reference equations can alter the classification of obstruction severity for Black patients — a topic of ongoing scientific debate that has real implications for both diagnosis and treatment decisions. A thorough pulmonologist will interpret spirometry in full clinical context rather than relying solely on percent-predicted values.

Environmental Factors in South Florida's Black Communities

Environmental exposures are among the most powerful drivers of asthma disparities, and they are directly addressable. Broward County presents specific environmental challenges that disproportionately affect communities with older housing stock and proximity to major traffic corridors:

These triggers tend to cluster in the same environments — older multi-unit housing with cockroach and mold issues, near high-traffic roads, in the urban heat core. The cumulative trigger burden this creates cannot be managed with rescue inhalers alone. It requires a systematic, specialist-led approach that identifies each patient's specific sensitization profile and addresses both pharmacologic and environmental components.

Systemic Barriers to Specialist Asthma Care

Medical Mistrust

The legacy of the Tuskegee syphilis study, documented instances of unequal treatment in clinical settings, and lived experiences of racial bias in healthcare create legitimate mistrust of the medical system in many Black communities. This mistrust is rational — it is a response to documented historical and contemporary harm — and dismissing it is counterproductive. Building a therapeutic relationship with a specialist who listens, explains fully, and engages respectfully is essential to sustained asthma management.

Underdiagnosis and Undertreatment

Research published in the American Journal of Respiratory and Critical Care Medicine and CHEST documents that Black patients with equivalent asthma severity are less likely to be referred to a pulmonologist, less likely to be prescribed inhaled corticosteroid (ICS) controller therapy, and more likely to be managed with rescue bronchodilators alone compared to white patients presenting with the same clinical picture. This is not a clinical outcome gap caused by biology — it is a care gap caused by implicit bias and structural inequities in referral pathways.

Controller Medication Cost and Adherence

Inhaled corticosteroid combination inhalers can cost $200-$400 per month without insurance coverage. For patients without adequate coverage, the financial barrier to daily controller therapy is real. Generic ICS options exist, but patient education about which medications to prioritize when resources are limited requires specialist guidance that an emergency department visit cannot provide.

Lack of Insurance and Cost-Sharing

Uninsurance rates remain higher in Black communities than in non-Hispanic white communities in Florida. Even insured patients face specialist copays, referral requirements, and high-deductible plans that create financial friction at every step toward appropriate care.

Biologic Therapies: Closing the Treatment Gap

Five FDA-approved biologic therapies have transformed outcomes for severe asthma. Clinical trial data and real-world evidence demonstrate efficacy in Black patients, yet Black individuals remain underrepresented in biologic clinical trials and underreferred for biologic evaluation in practice. Closing this gap requires both access and awareness.

Tezepelumab deserves particular attention for Black patients, given the higher prevalence of non-eosinophilic severe asthma in this population. As the only approved biologic that targets the upstream epithelial cytokine TSLP, it has demonstrated significant exacerbation reduction in patients who would not qualify for eosinophil-targeted biologics under traditional criteria.

All five manufacturers operate patient assistance programs. Advanced Asthma Clinic can submit PAP applications on behalf of qualifying patients and manage the entire prior authorization process.

Clinical Trial Participation: An Equity Opportunity

Black and African American patients have historically been underrepresented in clinical trials for asthma biologics — which means that much of the evidence base was generated in populations that may not fully reflect the biology, environmental context, or treatment response of Black patients. Greater diversity in clinical trials benefits both individual participants and the field as a whole.

Lung Research Florida, co-located with Advanced Asthma Clinic, conducts FDA-regulated clinical trials in severe asthma, COPD, chronic cough, and bronchiectasis. Eligible participants receive all study-related care, evaluations, and investigational medications at no charge. Call 954-520-7296 x1 for trial eligibility information.

What Comprehensive Asthma Care Looks Like

For a Black or African American patient presenting to Advanced Asthma Clinic — whether newly diagnosed or with longstanding poorly controlled asthma — a complete evaluation includes:

1. Full symptom and trigger history — including housing conditions, occupational exposures (construction, healthcare, transportation), neighborhood environment, and prior medication use
2. Asthma Control Test (ACT) scoring — objective baseline against which to measure improvement
3. Spirometry with bronchodilator response — interpreted in full clinical context, not just percent-predicted cutoffs
4. FeNO (fractional exhaled nitric oxide) — measuring type-2 airway inflammation to guide therapy selection
5. Blood eosinophil count and total IgE — key biomarkers for biologic eligibility determination
6. Allergen sensitivity testing — identifying cockroach, dust mite, mold, pet dander, and pollen sensitization
7. Review of current medication regimen — identifying step-up opportunities; assessing rescue vs. controller ratio as a severity marker
8. Environmental counseling — practical, affordable trigger-reduction strategies tailored to the patient's actual living situation
9. Financial navigation — proactive identification of PAP eligibility, Better Breathing Grant options, and generic substitution opportunities

South Florida Communities We Serve

Advanced Asthma Clinic is located at 10059 NW 1st Court, Plantation, FL 33324 — centrally positioned within Broward County and accessible from communities throughout the region. We serve patients from Fort Lauderdale, Lauderhill, Lauderdale Lakes, Oakland Park, Pompano Beach, Deerfield Beach, North Lauderdale, Margate, Tamarac, Coconut Creek, Miramar, Hollywood, Davie, Cooper City, and Weston.

Dr. Frank Hull, M.D., has more than 20 years of experience in pulmonary medicine and asthma research. Our approach is protocol-driven, biomarker-guided, and built around the principle that every patient — regardless of insurance status, language, or zip code — deserves access to the best available asthma care.

Frequently Asked Questions

Do Black and African American people have higher asthma rates?

Yes. Black, non-Hispanic Americans have a current asthma prevalence of approximately 11.5%, compared to a national average of about 8.0%. Black children have even higher rates — approximately 13–14%. More critically, Black Americans die from asthma at approximately three times the rate of white Americans, the most severe racial disparity in asthma outcomes.

Why do Black Americans have higher asthma mortality?

Mortality disparities reflect a convergence of environmental trigger exposure (cockroach allergen, traffic pollution, urban heat), lower rates of specialist referral and prescribed controller medications, medical mistrust reducing healthcare engagement, and financial barriers to consistent care. These are largely preventable with appropriate specialist-led management.

Are biologic asthma treatments available to patients who cannot afford them?

Yes. All five FDA-approved asthma biologics have manufacturer patient assistance programs that provide medication at no cost for qualifying patients. Advanced Asthma Clinic can help identify eligibility and manage the application process. Call 954-522-7226 to discuss your situation.

How does implicit bias affect asthma care for Black patients?

Research has documented that Black patients with equivalent asthma severity are less likely to be referred to a specialist, less likely to receive inhaled corticosteroid controller therapy, and more likely to rely solely on rescue inhalers. Choosing a specialist with protocol-driven, evidence-based care practices can help address this gap. Always consult your physician to discuss your full range of treatment options.

What Broward County communities does Advanced Asthma Clinic serve?

We serve patients from Fort Lauderdale, Lauderhill, Lauderdale Lakes, Oakland Park, Pompano Beach, Deerfield Beach, North Lauderdale, Margate, Tamarac, Coconut Creek, Miramar, Hollywood, Davie, Cooper City, Weston, and throughout Broward County. Call 954-522-7226 to schedule.

This article is for general informational and educational purposes only. It does not constitute medical advice and does not replace a consultation with a qualified healthcare provider. Always consult your physician regarding your individual symptoms, diagnosis, and treatment options. Advanced Asthma Clinic | 10059 NW 1st Court, Plantation, FL 33324 | 954-522-7226.