Disparities/Minority Health

Inner-city Hispanic adults with limited English proficiency have poorer asthma control and quality of life

Adults with asthma must know how to manage their symptoms by avoiding asthma triggers, using the right medications, and monitoring their breathing capacity with peak flow meters. A new study links limited English proficiency (LEP), which can interfere with doctor-patient communication essential to learning about asthma self-management, to poorer asthma control, higher care use, and lower quality of life among inner-city Hispanic adults with asthma. A team led by Juan P. Wisnivesky, M.D., M.P.H., of the Mount Sinai School of Medicine, interviewed 318 adults with persistent asthma receiving care at 2 large inner-city clinics.

The team classified them into three groups: non-Hispanics (all native English speakers), Hispanics proficient in English, and Hispanics with LEP. The researchers asked them to fill out questionnaires on asthma control and quality of life and obtained data on their use of care at 1 and 3 months after study enrollment.

Hispanics with LEP had significantly worse asthma control and quality of life scores compared with non-Hispanic asthmatics. Yet, quality of life scores were not significantly different among patients with adequate English language proficiency, regardless of ethnicity. Hispanics with LEP were 2.4 times more likely to suffer an asthma episode requiring outpatient treatment and 4.4 times more likely to suffer an episode requiring an emergency department visit or hospitalization compared with non-Hispanic patients. LEP was also associated with more worries about side effects or becoming addicted to inhaled corticosteroids (ICS), beliefs that asthma is an acute (rather than chronic) disease, decreased self-efficacy (in ability to control asthma and use ICS), and lower adherence to controller medications. These findings suggest that Hispanics with asthma and LEP are at high risk for poor outcomes. The study was supported in part by the Agency for Healthcare Research and Quality (HS13312).

See "Assessing the relationship between language proficiency and asthma morbidity among inner-city asthmatics," by Dr. Wisnivesky, Meyer Kattan, M.D., David Evans, Ph.D., and others, in the February 2009 Medical Care 47(2), pp. 243-249.

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