A study of over 1.1 million American adults with asthma found that Black, Hispanic, and Asian patients use ICS, LABA and LAMA inhalers less frequently than white patients.


RT’s Three Key Takeaways:

  1. Controller Medication Gaps: Research involving over 1.1 million Americans found that Black, Hispanic, and Asian patients use guideline-recommended controller inhalers less frequently than white patients.
  2. Socioeconomic Barriers: Disparities in inhaler use are largely attributed to sociodemographic factors, including income, education, insurance status, and access to specialty healthcare providers.
  3. Inadequate Asthma Control: Minority groups were found to rely more on short-acting beta-agonists for quick relief, suggesting that their conditions may be undertreated or poorly managed.


New research led by University of California, Los Angeles (UCLA) indicates that Black, Hispanic, and Asian patients use daily controller inhalers less frequently than white patients, even though clinical guidelines recommend them as the standard of care for asthma.

The study, published in JAMA, suggests that socioeconomic factors and a lack of access to specialty healthcare are the primary causes of these treatment gaps. While asthma affects individuals across all racial and ethnic groups, the researchers noted that access to effective medications can significantly improve patient quality of life.

“This is a really important extension of the data from the late 90s, given the fact that we have more access to care since the late 1990s and 2000s and we have a lot more people with health insurance through policies like the Affordable Care Act, so we have more people engaged in medical care and still see these gaps in treatment,” said Utibe Essien, assistant professor of medicine, division of general internal medicine and health services research, at the David Geffen School of Medicine at UCLA, in a news release.

Researchers analyzed data from the Medical Expenditure Panel Survey (MEPS) from 2014 through 2023. The sample included approximately 10,500 US adults, representing more than 1.1 million Americans aged 18 and older receiving treatment for asthma. The study population was 55% white, 20% Black, 16% Hispanic, and 3% Asian.

The study tracked the use of several types of inhalers:

  • Inhaled corticosteroids (ICS) to reduce airway inflammation.
  • Long-acting beta agonists (LABA) for long-term airway maintenance.
  • Long-acting muscarinic antagonist (LAMA) to relax airway muscles.
  • Short-acting beta-agonists (SABA) for quick relief during asthma attacks.

Overall, they found that more whites used ICS, LABA and LAMA inhalers, but fewer SABA inhalers, compared with the other groups. After adjusting for ethnicity and socioeconomic factors, the researchers broke down some inhaler usage as follows:

  • 30% of Asians,  34% of Blacks, and 35% of Hispanics used ICS compared with 39% of whites
  • 21% of Asians, 27% of Blacks, and 25% of Hispanics used LABA vs 32% of whites
  • 3% of Asians and Hispanics, and 4% of Blacks used LAMA vs 6% of whites.

The data showed that white patients used ICS, LABA, and LAMA inhalers at higher rates than other groups. Conversely, minority groups utilized fewer controller medications and relied more on SABA inhalers. Frequent reliance on SABA inhalers often indicates that a patient’s asthma is not well controlled and may be undertreated.

The Complexity of Pharmacoequity

After adjusting for ethnicity and socioeconomic factors, the researchers found that the differences in ICS utilization were mostly attenuated. This suggests that access-related factors are the primary drivers of treatment variation.

“However, these factors—including income, education, insurance status, and access to specialty care—are themselves affected by racial and ethnic disparities, underscoring the complexity of achieving pharmacoequity,” the researchers wrote in the study.

The research team expressed surprise that the widest gaps occurred in the use of short-acting inhalers, which are typically less expensive and easier to obtain. Essien noted that this highlights the difficulty of treating asthma as guidelines and policies evolve.

“Again, that underscores the complexity of treating asthma when policies change and guidelines change in terms of what is recommended versus not recommended, which doctors have access to those guidelines, and how patients change their treatment based on those new guidelines,” said Essien.