Asthma in Hispanics. An 8-Year Update

Abstract

This review provides an update on asthma in Hispanics, a diverse group tracing their ancestry to countries previously under Spanish rule. A marked variability in the prevalence and morbidity from asthma remains among Hispanic subgroups in the United States and Hispanic America. In the United States, Puerto Ricans and Mexican Americans have high and low burdens of asthma, respectively (the "Hispanic Paradox"). This wide divergence in asthma morbidity among Hispanic subgroups is multifactorial, likely reflecting the effects of known (secondhand tobacco smoke, air pollution, psychosocial stress, obesity, inadequate treatment) and potential (genetic variants, urbanization, vitamin D insufficiency, and eradication of parasitic infections) risk factors. Barriers to adequate asthma management in Hispanics include economic and educational disadvantages, lack of health insurance, and no access to or poor adherence with controller medications such as inhaled corticosteroids. Although considerable progress has been made in our understanding of asthma in Hispanic subgroups, many questions remain. Studies of asthma in Hispanic America should focus on environmental or lifestyle factors that are more relevant to asthma in this region (e.g., urbanization, air pollution, parasitism, and stress). In the United States, research studies should focus on risk factors that are known to or may diverge among Hispanic subgroups, including but not limited to epigenetic variation, prematurity, vitamin D level, diet, and stress. Clinical trials of culturally appropriate interventions that address multiple aspects of asthma management in Hispanic subgroups should be prioritized for funding. Ensuring high-quality healthcare for all remains a pillar of eliminating asthma disparities.

Asthma in Latin America

“…7 Increased understanding of asthma in this region should lead to better prevention, diagnosis and treatment of this disease in Latin Americans.…”

Gun Violence, African Ancestry, and Asthma

“…3 The reasons behind racial or ethnic disparities in asthma prevalence are unclear, but likely result from complex interactions between genetics and environmental factors. 4 Puerto Ricans and African Americans have a higher percentage of African ancestry than non-Hispanic whites or Mexican Americans, [5][6][7] and previous findings suggest that African ancestry partly explains the higher burden of asthma in these populations. 7,8 Indeed, several studies have shown that African ancestry is associated with an increased risk of asthma and/or reduced lung function in Puerto Ricans and African Americans.…”

“…7,8 Indeed, several studies have shown that African ancestry is associated with an increased risk of asthma and/or reduced lung function in Puerto Ricans and African Americans. [7][8][9][10][11][12][13][14] Exposure to violence is common among Puerto Rican and African American children 4,[15][16][17][18] and could thus partly explain the observed link between African ancestry and asthma. Exposure to violence is increasingly being recognized as a potentially modifiable risk factor for childhood asthma.…”

Sensibilización IgE y las condiciones sociodemográficas como determinantes en la gravedad del asma

“…También puede responder a que la ancestría genética de la población del trópico tiene una distribución de genes amerindios, de raza negra y caucásica diferente a las reportadas en otras latitudes, lo que genera que un cluster de genes asociados con la respuesta inmunológica varíe y pueda predisponer a mayor sensibilización. 21,22 La distribución de la severidad de asma en leve, moderada y severa fue similar a la encontrada en otros estudios, 23 donde se identificó una prevalencia de asma grave o de difícil manejo en 5 a 10 % de los pacientes pediátricos. Debido a que nuestra población fue reclutada en un centro de referencia especializado de alergología, las cifras de pacientes con enfermedad grave en teoría podrían estar sobrevaloradas.…”