Severe Asthma in Sexual and Gender Minoritized Adults: What Can We Do?

Sexual and gender minoritized (SGM) adults are at increased risk for severe asthma, according to an analysis of a nationally representative study presented at the CHEST annual meeting hosted by the American College of Chest Physicians.

In this exclusive MedPage Today video, investigator Tugba Kaplan, MD, of Luminis Health-Anne Arundel Medical Center in Annapolis, Maryland, discusses the study design and results, and the importance of future research and interventions to reduce these risks.

Following is a transcript of her remarks:

Our study actually aimed to see if there is any relationship between this asthma severity among the sexual and gender minoritized people. And we use this PATH (Population Assessment of Tobacco and Health) study dataset because it’s not coming from only a state or a hospital. This is a nationally representative study.

And we used the six questions to be able to assess this asthma severity. Because in daily practice when we are assessing a patient’s asthma severity as clinicians, retrospectively we ask some questions regarding symptoms and also we try to understand patient’s lung capacity. And for that we use this asthma severity classification tool — based on just our recent guidelines — and it includes the symptom questions. So we just use this tool and then we classified the responses, just dichotomized these responses as intermittent and persistent asthma.

These results showed us, regarding the asthma severity symptom questions, there was increased odds for some symptoms. Asthma attacks that required steroid use was found to increase 1.47 times in the SGM population. And asthma attacks that kept from daily activity was also increased. And shortness of breath was just the most severe symptom in that population.

We controlled age, sex, race/ethnicity, education level, body mass index, physical activity, and regular asthma medication use in our statistical model. But regarding the tobacco use, we classified the tobacco use as dual use cigarette use, only e-cigarette users who were former smokers, and never-users, and also lifetime exclusively only e-cigarette users.

Overall, I can tell an increased risk of asthma severity was observed among the adult SGM people compared to the straight people in this nationally representative longitudinal study. We can tell the SGM people unfortunately [are] experiencing several healthcare disparities. There is just gaps in insurance coverage. Sometimes the healthcare systems, they have limited awareness about these SGM health issues, and asthma is one of them, I can definitely tell.

And sometimes concern of discrimination by healthcare providers among these people can result in less access to regular healthcare visits and it can cause some poor health outcomes. And it’s so important because [in] asthma and other chronic illnesses, it’s crucial to offer patients the knowledge and the tools required to proficiently handle their conditions. And we need to have good interactions with our patients. And we need to just help them understand the severity of the situation and their health conditions.

So I think in that regard, that it’s important to create some future research to identify and develop culturally appropriate interventions to reduce this, just the asthma severity and other respiratory health risks among SGM people. And for fear of health outcomes, it is imperative to implement specific health promotion efforts tailored to different cultures, including SGM people. And I think we should offer a cultural sensitivity training to the healthcare professionals and conduct future research with a focus on targeted interventions.

Because I don’t want to just make this premature closure, yes, these SGM people, they have this increased use of tobacco use and then it’s causing asthma severity, yes, there’s some components of that. But also maybe they are under emotional stress and there are some issues regarding healthcare disparities and we are not exactly helping these people in our best ability. So our goal is to do our best to be able to help this population and particularly help them to have regular physician visits and better management on their chronic diseases, including asthma.

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