Do Asthma Medications Work Differently for Black Children? Plus 4 More Things Parents Should Know
Key takeaways:
If your child’s asthma isn’t controlled with their current medication, their provider may take a step-up approach to find the right treatment. Some Black children may respond better to certain step-up asthma treatments than other options.
If your child doesn’t respond to the recommended asthma treatment, talk to their healthcare provider. There are other options to manage asthma symptoms.
Monitoring your child’s asthma symptoms and medication use can help ensure they’re receiving the right treatment. Checking for asthma triggers in your house and removing them can also go a long way to help your child’s asthma.
Asthma is a chronic respiratory condition that touches the lives of millions of children in the U.S. Initial treatment often includes low-dose inhaled steroids to lessen inflammation in the lungs. A fast-acting rescue inhaler may also be added. But for some children, this may not be enough.
If your child’s asthma symptoms are uncontrolled, their healthcare provider will typically follow a step-up approach, which involves adjusting doses or adding new medications. However, these guidelines are often based on studies that didn’t include many Black participants. And recent research has found that some Black children may respond better to different treatments, too.
Does this mean that certain asthma medications work differently or not as well for Black children? Not necessarily. But their provider may need to tailor their treatment plan. Let’s take a closer look at what you need to know to ensure your child is getting the best asthma treatment.
Research suggests that some Black children may respond better to different asthma treatments
To better understand how Black individuals respond to asthma treatments, researchers launched the Best African American Response to Asthma Drugs (BARD) trials. These trials were important because Black people are disproportionately affected by asthma. Participants had at least one grandparent who was African American.
One BARD trial compared different asthma treatments in Black children ages 5 to 11 years old. The children were taking low doses of fluticasone, an inhaled steroid. But their asthma symptoms were still uncontrolled.
Researchers compared the effect of different fluticasone doses — with and without the addition of salmeterol. Salmeterol is a long-acting bronchodilator that relaxes the airways and makes it easier to breathe.
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Results showed that half of the Black children had better control of their asthma when they added salmeterol. The other half of the group had better control when their fluticasone dose was increased. These results were different from those seen in studies with mostly white children, where medications like salmeterol typically produced better results.
Researchers don’t know for sure why some children may respond differently to asthma treatments. And it’s not clear how these findings might apply to children who are multiracial. But there may be certain genetic factors that need to be researched further.
So, what might these findings mean for your child? The short answer is that the current step-up approach may not work for everyone.
If your child isn’t responding to their current asthma treatment, there are other options
It can be frustrating to see your child not responding to treatment. Usually, the next step includes adding on another treatment, or increasing their medication dose.
One option your child’s healthcare provider may suggest is a combination steroid / bronchodilator inhaler. Preferred products include budesonide / formoterol (Symbicort) and mometasone / formoterol (Dulera). Experts recommend using one of these inhalers as both a daily treatment (to control symptoms) and rescue treatment (to relieve symptoms quickly) in children ages 4 and older. This can be a convenient option since you’ll only need to keep track of one inhaler.
Depending on your child’s age, other options their provider may consider include:
Biologics, like omalizumab (Xolair)
Leukotriene receptor antagonists, like montelukast (Singulair)
Monitoring your child’s asthma symptoms and medication use helps ensure they’re getting the proper treatment
As a parent or caregiver, you want to make sure your child is receiving the right treatment to keep their asthma symptoms under control. Not only does this keep them healthy, but it helps prevent trips to the emergency room when their symptoms flare up.
Monitoring medication use
Maintenance (controller) medications are a central part of asthma treatment. These are medications taken every day to help keep symptoms under control. Yet about half of children on a controller medication don’t take it as prescribed.
If your child is using their quick-relief (rescue) medication more than twice a week, this may be a sign that they don’t use their controller medication often enough. It can also mean that their asthma medications need to be adjusted.
Monitoring symptoms
Monitoring your child’s asthma symptoms is one way you can help ensure they’re using the right treatment.
How often does your child have symptoms during the week? If they have symptoms more than 2 days a week, their asthma may not be well controlled. This may also be the case if their symptoms wake them more than 1 or 2 nights every month.
Can your child do all of their normal activities? If your child’s symptoms are getting in the way of their normal activities, this may be a sign their asthma isn’t being controlled.
How many asthma attacks do they have each year that require them to take oral medications? If they have more than one attack like that a year, it may be a sign that their asthma isn’t well controlled.
Another tool to monitor your child’s symptoms is a peak flow meter. A peak flow meter measures how well a person can blow air out of their lungs. Discuss with your child’s healthcare provider what the normal peak flow measurement is for your child.
Creating an asthma action plan
An asthma action plan is something that you, your child, their provider come up with. It gives instructions for when your child should take specific asthma medications, and when medical attention is needed. When symptoms happen, this helps to make sure they’re treated appropriately.
Other people in your child’s life, including their teachers, family members, and other caregivers should be aware of their asthma action plan.
There are things you can do at home to help improve your child’s asthma control
Helping your child manage their asthma symptoms can feel overwhelming. The good news is that there are simple things you can do at home. For example, research has shown that learning about asthma triggers and how to lessen them can go a long way.
Some of these triggers include:
Tobacco smoke: Making the house a smoke-free zone can make a big difference for your child’s symptoms.
Pet hair: If your child is allergic to pets, washing the pet regularly can help. And so can keeping them outside of the bedrooms.
Dust mites: Washing the sheets weekly can help reduce dust mites. It’s also important to vacuum your floors regularly. Allergen-proof bedding can help, too. And studies have shown that using an air purifier can help decrease asthma symptoms.
Mold: If you have any water leak in the house, fix it as soon as possible. Using a dehumidifier to lower the humidity in the house can also help prevent mold from growing.
Cockroaches: Keeping your kitchen clean and free of clutter can help keep away cockroaches. Avoid pesticide sprays since this can trigger asthma symptoms. Opt for baits or traps instead.
There are ways to save on your child’s asthma treatment
Many asthma inhalers are only available as brand-name products. This can create another barrier to accessing affordable care for your child. Fortunately, there are several ways to save:
Authorized generics: These are brand-name inhalers without the brand name on the label. Not all inhalers have authorized generics, but they can be a more affordable option.
Generics: Most inhalers don’t have lower-cost generics, but a few of them do. Ask your pharmacist if a generic option is available for your child’s medication.
GoodRx discounts: GoodRx can help you save money on both brand-name and generic asthma medications. Search for your child’s medication to find ways to save.
Manufacturer copay cards: If your child is eligible, they may qualify for a manufacturer copay card. This can help make a brand-name medication more affordable.
Patient assistance programs: If your child is eligible, they may be able to get their medication at no cost through one of these programs.
The bottom line
When it comes to asthma treatments, one size doesn’t fit all — especially for Black children. Following the recommended step-up approach may work for some children, but others may need a different strategy to control their asthma symptoms.
If your child doesn’t respond to their asthma treatment, talk to their healthcare provider. They can work with you and your child to find an approach that works.
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References
American Lung Association. (2023). Measuring your peak flow rate.
Centers for Disease Control and Prevention. (2018). Asthma in children.
Cloutier, M. M., et al. (2021). The 2020 focused updates to the NIH asthma management guidelines: Key points for pediatricians. Pediatrics.
Ebell, M. H., et al. (2019). A multicomponent, multi-trigger intervention to enhance asthma control in high-risk African American children. Preventing Chronic Disease.
Global Initiative for Asthma. (2022). Global strategy for asthma management and prevention (2022 update).
James, C., et al. (2020). HEPA filtration improves asthma control in children exposed to traffic-related airborne particles. Indoor Air.
National Heart, Lung, and Blood Institute. (2020). AsthmaNet best African American response to asthma drugs (BARD).
NIH Research Matters. (2019). African American children may need different asthma treatments. National Institutes of Health.
Ortega, V. E., et al. (2021). Pharmacogenetic studies of long-acting beta agonist and inhaled corticosteroid response in randomized controlled trials of African descent minorities with asthma. The Lancet Child & Adolescent Health.
U.S. Department of Health and Human Services Office of Minority Health. (2022). Asthma and African Americans. HHS.gov.
U.S. Environmental Protection Agency. (2018). Strategies for addressing asthma in homes.
Wechsler, M. E., et al. (2019). Step-up therapy in Black children and adults with poorly controlled asthma. The New England Journal of Medicine.
