Findings from the 2017-2021 Medicare Current Beneficiary Surveys (MCBS)

Recent national data indicates that 8% of adults ages 18 and older in the United States have current asthma (Centers for Disease Control and Prevention, 2023). However, those rates vary based on sex, race, ethnicity, and age. Among U.S. adults, asthma is more prevalent in females (9.7%) compared to males (6.2%). In terms of race and ethnicity, asthma is most prevalent in non-Hispanic American Indian/Alaskan Natives (13.3%), followed by non-Hispanic Blacks (10.7%), and non-Hispanic Whites (8.0%). It is least prevalent among Hispanics (6.7%) and non-Hispanic Asians (4.2%).

When looking more specifically at older adults (ages 65 and older), 7.2% have current asthma nationally, accounting for approximately 20% of individuals with asthma in the United States (Centers for Disease Control and Prevention, 2023). However, asthma prevalence is likely higher among older adults, as it is widely understood to be underdiagnosed in the older population (Gibson et al., 2010). This is attributed to a combination of factors unique to older adults, including changes in lung structure and function (Dunn et al., 2017), challenges administering and interpreting pulmonary functioning tests used for diagnosis (Battaglia et al., 2016), an increase in comorbidities such as chronic obstructive pulmonary disease (COPD) (Tzortzaki et al., 2011), and complications related to polypharmacy (Battaglia et al., 2016). Additionally, asthma tends to be less controlled in older adults when compared to younger age groups, and mortality rates tend to be higher (Tsai et al., 2012; Talreja & Baptist, 2011). For example, asthma mortality rates in 2021 increased throughout the lifespan, with rates as low as 1.4 per million among those 0-4 years old, 2.4 per million among those 5-11, 2.0 per million among those 12-17, 3.8 per million among those 18-24, 6.4 per million among those 25-34, 11.5 per million among those 35-64, and 27.1 per million among those 65 and older (Centers for Disease Control and Prevention, 2023). The underdiagnoses, in conjunction with high mortality rates and a lack of literature on the disease among older adults, indicate a need for further investigation.

https://publish.illinois.edu/geigerevallab/medicare-current-beneficiary-survey-mcbs/

For children with asthma, access to quick-relief medications is critical to minimizing morbidity and mortality. An innovative and practical approach to ensure access at school is to maintain a supply of stock albuterol that can be used by any student who experiences respiratory distress. To make this possible, state laws allowing for stock albuterol are needed to improve medication access.

https://web.archive.org/web/20240420124321/https://www.atsjournals.org/doi/10.1164/rccm.202106-1550ST

Treatments for long-term control of asthma have improved and include a promising but expensive class of biologic therapies. However, the clinical trials evaluating these and other novel treatments have used a variety of different outcomes to evaluate efficacy. The evolution of asthma care calls for a re-examination of outcomes that are most important to patients and other stakeholders.

https://www.annallergy.org/article/S1081-1206(21)00256-8/abstract

Severe asthma is a subtype of asthma that can be hard to control, resulting in an exceptional impact on an individual's quality of life. The aim of this review article is to explore the misalignment of perceptions of severe asthma among different stakeholders to identify how to reduce burden and improve delivery of care.

https://www.worldallergyorganizationjournal.org/article/S1939-4551(20)30403-8/fulltext

Severe asthma is a debilitating, life-threatening disease associated with substantial global morbidity, mortality, and health care resource utilization. Patients may not receive guideline-directed medical care for severe asthma. Moreover, viable precision-based assessment tools and newer preventive therapies that can reduce the frequency of exacerbations and associated functional impact are underused. As a result, high rates of poorly controlled severe asthma persist, and patient health-related quality of life suffers.

https://link.springer.com/article/10.1007/s12325-020-01450-7

Hispanic/Latinx (HL) ethnicity incorporates many subgroups from diverse racial and cultural backgrounds. Studies suggest that Puerto Ricans (PR) have a greater asthma prevalence and asthma-related morbidity relative to White and Mexican counterparts. However, these studies were in children or limited in clinical and phenotypic characterization. Our purpose was to determine whether clinical, phenotypic differences, and disparities in asthma-related morbidity exist across adult HL subgroups. Considering the shared heritage between PR and other Caribbean HL (Cubans and Dominicans, C&D), we hypothesized that Caribbean HL (CHL; PR and C&D) adults would have greater asthma morbidity compared to other HLs (OHL; Mexicans, Spaniards, Central/South Americans).

https://journal.chestnet.org/article/S0012-3692(21)01523-3/fulltext

Little is known about how patients with asthma and eczema perceive their medical care and burden of disease. A survey was conducted to evaluate the perceptions among the general patient population with asthma and/or eczema regarding disease and treatment burden and barriers to adequate care.

https://link.springer.com/article/10.1007/s12325-021-02021-0

Background

In response to racial inequity in asthma, asthma-related research among diverse patients is vital. However, people from historically marginalized groups are underrepresented in clinical and patient-centered outcomes research (PCOR). The “Black People Like Me” (BPLM) virtual conference series was developed to: (1) engage Black patients with asthma and their caregivers in education and discussions about asthma, and (2) encourage involvement in PCOR. Education about COVID-19 and COVID-19 vaccination was also incorporated.

Background

Many patients have uncontrolled asthma despite available treatments. Most of the new asthma therapies have focused on type 2 (T2) inflammation, leaving an unmet need for innovative research into mechanisms of asthma beyond T2 and immunity. An international group of investigators developed the International Collaborative Asthma Network (ICAN) with the goal of sharing innovative research on disease mechanisms, developing new technologies and therapies, organising pilot studies and engaging early-stage career investigators from across the world. This report describes the purpose, development and outcomes of the first ICAN forum.

https://publications.ersnet.org/content/erjor/9/3/00090-2023

There are now several monoclonal antibody (mAb) therapies (“biologics”) available to treat severe asthma. Omalizumab is an anti-IgE mAb and is licensed in severe allergic asthma. Current evidence suggests it may decrease exacerbations by augmenting deficient antiviral immune responses in asthma. Like all other biologics, clinical efficacy is greatest in those with elevated T2 biomarkers. Three biologics target the interleukin (IL)-5–eosinophil pathway, including mepolizumab and reslizumab that target IL-5 itself, and benralizumab that targets the IL-5 receptor (IL-5R-α). These drugs all reduce the exacerbation rate in those with raised blood eosinophil counts. Mepolizumab and benralizumab have also demonstrated steroid-sparing efficacy. Reslizumab is the only biologic that is given intravenously rather than by the subcutaneous route. Dupilumab targets the IL-4 receptor and like mepolizumab and benralizumab is effective at reducing exacerbation rate as well as oral corticosteroid requirements. It is also effective for the treatment of nasal polyposis and atopic dermatitis. Tezepelumab is an anti-TSLP (thymic stromal lymphopoietin) mAb that has recently completed phase 3 trials demonstrating significant reductions in exacerbation rate even at lower T2 biomarker thresholds. Many patients with severe asthma qualify for more than one biologic. To date, there are no head-to-head trials to aid physicians in this choice. However, post-hoc analyses have identified certain clinical characteristics that are associated with superior responses to some therapies. The presence of allergic and/or eosinophilic comorbidities, such as atopic dermatitis, nasal polyposis or eosinophilic granulomatosis with polyangiitis, that may additionally benefit by the choice of biologic should also be taken into consideration, as should patient preferences which may include dosing frequency. To date, all biologics have been shown to have excellent safety profiles.

https://pmc.ncbi.nlm.nih.gov/articles/PMC8919802/