Alternative Medicine Results Differ Across Asthma Patient Races, Ethnicities

A new study sampling data from the National Health Interview Survey (NHIS) found differing uses and results of complementary alternative medicine (CAM) in adults with asthma across ethnicities.

The study, conducted by a team of investigators at Northwell Health and presented at the 2018 CHEST Annual Meeting in San Antonio, TX, is also the first to suggest that CAM may be associated with a decreased risk of emergency department (ED) visits for asthma exacerbations.

Presented by investigator and third-year medical student Joseph Simonson, the study emphasized the alternative medicine data previously underutilized from the 2012 NHIS report. Though such therapies—including yoga, acupuncture, and meditation, among others—can serve as either lone therapy or in complementary to standard care, investigators focused primarily on the latter role. That said, recent trials have evidenced that minority patient groups in particular are more likely to worsen their treatment adherence while embracing alternative medicine measures.

“So CAM may be actually contributing to some of the racial and ethnic disparities we see in asthma outcomes,” Simonson said.

In analyzing the 2012 NHIS survey respondents aged 18 years and older, investigators identified 34,525 adults. Among them, about two-thirds (66.5%) were white, 14.9% were Hispanic, 11.5% were black, 5.2% were Asian, and 2.0% identified as “other.” Of the 4387 (12.7%) to have asthma, 69% were white, 13.4% black, 11.8% Hispanic, 3% Asian, and 2.8% other.

Investigators set a primary outcome variable of ED visits within the past year for asthma exacerbation, while performing descriptive analysis on ED visits for asthma exacerbation and CAM use. Through multivariable logistic regression and adjusting for age, gender, and healthcare provider use, they examined the relationship between CAM use and ED visits for asthma exacerbations both across all asthma patients, and again among different racial and ethnic groups.

Among all patients with asthma, 49% had reported an exacerbation in the past year, and 12% reported an ED visit for their asthma in the past year (P < .05). Among racial and ethnic groups, Hispanic patients reported the greatest prevalence of exacerbations (54%), and black patients reported the greatest prevalence of ED visits for asthma (22%).

In assessing for healthcare access, just white patients (77%) reported a greater percentage of healthcare access than the overall patient population average (74%). They also reported the greatest percentage of CAM users (63%), while just 47% and 45% of black and Hispanic patients reported using CAM, respectively (P < .05).

Among specific forms of CAM used by patients with asthma, all racial and ethnic groups reported vitamins and minerals being their most commonly used practices in the past 12 years, and herbal and yoga practices being the least used practices.

The odds ratio (OR) of any CAM use and asthma exacerbation was most significant in Hispanics (1.43; P < .1), while white patients reported a 2.06 OR for exacerbations when practicing alternative treatments (P < .05).

Blacks and Hispanic patients were more likely to have an ED visit for asthma exacerbation and yet were less likely to use CAM patients. And particularly among Hispanic patients, herbal use was significantly associated with decreased ED visits for asthma exacerbation. Though sociodemographic characteristics among groups may be association between decreased hospitalization or exacerbation rates and increased CAM, Simonson emphasized the importance of psychosocial-driven asthma control.

“CAM appear protective of ED visits and for an asthma attack patient, and this may be because the CAM is complementary—used alongside asthma medications and possibly a marker for self-help behavior for people doing everything they can for asthma,” Simonson said.

Future studies, Simonson suggested, could delve into whether CAM is being used additionally or in substitution of asthma therapy, and what factors could contribute to the use of CAM across different groups.

The study, “Association Between Complementary Alternative Medicine Use and Emergency Department Visits for Asthma Exacerbation Across the American Population and Among Racial Minority Groups,” was presented at CHEST 2018.

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