improving the quality of life for people with asthma and
allergies and their families through education, advocacy, and
research. AAFA, a not-for-profit organization founded in
1953, provides practical information, community based
services, support, and referrals through a national network
of chapters and educational support groups. AAFA also
raises funds for asthma and allergy research.

Since 1953, NPC has sponsored and conducted scientific,
evidence-based analyses of the appropriate use of
pharmaceuticals and the clinical and economic value of
pharmaceutical innovations. NPC provides educational
resources to a variety of health care stakeholders, including
patients, clinicians, payers, and policy makers. More than
20 research-based pharmaceutical companies are members
of NPC.

This report was prepared by AAFA Policy Director
Mo Mayrides and NPC Vice President Richard Levy in
collaboration with SCRIBCO. Deborah Kline and Jean
Polatsek of NPC contributed editorial support and Anju
Kanumalla in association with SCRIBCO provided medical
writing assistance.

AAFA and NPC thank the following individuals for their
generous time, advice and expertise in reviewing the factual
content of this paper:

Peter Gergen, MD, MPH
Medical Officer
Asthma, Allergy and Inflammation Branch
Asthma and Inflammation Section
National Institute of Allergy and Infectious Diseases
National Institutes of Health

David L. Núñez, MD, MPH
Chief, California Asthma Public Health Initiative
Medicine and Public Health Section
California Department of Health Services

National Pharmaceutical Council
1894 Preston White Drive
Reston, VA 20191-5433

703-620-6390
info@npcnow.com
www.npcnow.org

• In the United States the burden of asthma falls
disproportionately on the black and Hispanic—largely
Puerto Rican—populations, and especially on minority
children. These groups have disproportionately high rates
of poor asthma outcomes, including hospitalizations and
deaths. This burden has environmental, socioeconomic,
and behavioral causes.

• As much as 40 percent of the risk of asthma in minority
children is attributable to exposure to residential allergens
that could be reduced, if not eliminated. Access to care is
hampered by socioeconomic disparities, shortages of
primary care physicians in minority communities, and
language and literacy barriers. A pattern of health care
behavior characterized by the underuse of long-term
control medications and a reliance on episodic and
emergency care is common in black and Hispanic
Americans with asthma.

• Underuse of asthma medicines, especially of long-term
control medications, is more common in minority than in
white children. Specifically, minority children are less likely
than white children to use inhaled corticosteroids, which
are recommended long-term control medications.

• Underuse of asthma medications can reflect breakdown
along the sequence of behaviors required for adequate
therapy: (1) under-prescribing, (2) not filling prescriptions,
and (3) poor compliance with filled prescriptions. Failure at
each of these stages has been reported for minority
children with asthma, in some cases at a higher rate than
for white children.

•Adherence to asthma medication regimens in minority
children may be compromised by their parents’ beliefs
about the role and usefulness of medications, concerns
about adverse effects, poor literacy, and distrust of and
poor communication with physicians. Individualized,
culturally sensitive communication with minority families
can help avoid these problems.

• Increasing the
use of long-term
control
medications is
key to reducing
disparities in the
burden of
asthma.
Consistent use
of such
medications, especially within the context of asthma
management programs, can reduce the use of emergency
care and alleviate the burden of childhood asthma in
minorities.

• Asthma education and management programs designed
for minority groups can teach them how to use medication
inhalers correctly, correct false impressions about
medications, and explain the role of environmental triggers.
A number of such programs have been tested, particularly
among minority children, with demonstrable success. The
widespread adoption of such programs could potentially
alleviate a large proportion of the burden of asthma in
minority children and adults.