Innovations in asthma care can improve the health of Detroiters living with this chronic disease

Researchers and doctors are beginning to modernize asthma treatment using innovative therapies.

Asthma is a common, chronic and treatable lung disease that touches nearly every family in America. It affects people of all ages and costs our health care system about US$82 billion each year.

In Michigan, the problem is acute. About 12% of Michigan adults live with asthma, compared to almost 9% nationwide, according to the Centers for Disease Control and Prevention.

Nowhere is the burden heavier than in Detroit, which is ranked No. 1 in the U.S. as the most challenging place to live with asthma – based on prevalence, emergency department visits and deaths.

Between 2021 and 2023, the city’s adult asthma rate was 14.8%, compared with 11.5% statewide, according to data from the Michigan Department of Health and Human Services. Childhood asthma reaches nearly 15%, almost double the state average.

Between 2019 and 2023, Detroiters were hospitalized for asthma more often than residents elsewhere in the state. Black residents, women and people with lower incomes bear the greatest burden, facing higher rates of disease and worse outcomes, such as hospitalization.

Personalized care based on medical advances

My experience as an asthma specialist has taught me humility in the face of this complex disease. Over the past decade, I’ve learned the value of pausing and inviting each patient to reflect on their own journey with asthma.

For some, it is a new and confusing diagnosis – often accompanied by a degree of denial about having a chronic condition that needs constant management.

For others, this process gives them space to reflect on disease-related harms such as lifetime exposure to corticosteroids, which treat inflammation, or the number of emergency department visits they have endured.

Taking time to reflect also gives doctors and patients an opportunity to think about other issues affecting the patients’ health. For example, patients often struggle with the relationship between asthma and being overweight. It is hard for them to lose weight due to their symptoms or the side effects of oral steroids.

This mutual understanding becomes the foundation for a personalized care plan, often using the latest scientific advances in therapy. My colleagues and I at the University of Michigan are deeply involved in clinical trials investigating novel therapies and forward-thinking approaches to asthma care.

These approaches are centered in the long-held principle that a preventive and proactive approach to care is better than a reactive one.

The problem with ‘wait-and-see’ care

Decades of research show that asthma, while characterized by airway inflammation and spasming, is a heterogenous syndrome. This means it takes many forms and affects patients in different ways.

For some, asthma fades over time or remains mild and manageable. For others, it is a lifelong struggle, marked by frequent flare-ups, hospital visits, missed days at work or school and declining lung function.

Alarmingly, severe outcomes can happen even in those labeled as having “mild” asthma. A seemingly manageable episode can suddenly become serious, reminding us how easily this disease can be underestimated.

Most people seek help for asthma only when symptoms get bad. They may find themselves overusing a rescue inhaler or needing urgent care or the emergency department. These flare-ups, also called exacerbations, are serious.

Patients who have frequent exacerbations are more likely to have future flare-ups and face long-term risks such as loss of lung function or even death.

Even the medicines used to treat flare-ups carry risks. Just two courses of oral steroids per year can raise the risk of osteoporosis, diabetes or cardiovascular disease. It is also important to note that poorly controlled asthma or regularly needing higher-dosage inhalers can lead to irreversible airway damage and loss of lung function.

Many patients also rely on the emergency department for routine asthma care. This is often due to poor knowledge about asthma, high medication costs, insurance barriers and life constraints such as work or school. Yet emergency departments are not designed for ongoing management. Emergency departments cannot provide lung-function testing, maintenance inhalers, long-term monitoring or follow-up care – all critical to keeping asthma under control.

In other words, the health care field’s current approach is reactive, waiting for symptoms to spiral downward and not really focused on addressing risk. Patients with warning signs often go unnoticed or receive treatments that don’t meet their needs. This approach to care is outdated and poorly suited to modern medicine.

Tailoring interventions to each individual

A better approach starts with awareness of asthma’s variability and moving away from “one-size-fits-all” care.

Consider allergen control. Detroiters are exposed to both year-round allergens – such as dust mites, cockroaches and indoor molds – as well as seasonal allergens such as tree, grass and weed pollens.

Allergen mitigation was once a major strategy for managing asthma and often thought of as a stand-alone intervention. But allergen mitigation alone is rarely enough. For example, if dust mites trigger asthma, using mattress covers alone isn’t sufficient – you also need to wash bedding weekly and avoid heavy humidifiers. The approach should incorporate different methods to reduce exposure.

Meanwhile, allergen control for people without clear sensitivity is often ineffective and expensive. The best care starts with a conversation between patients and a clinician: testing triggers, reviewing evidence-based strategies and tailoring interventions to what will work for each person.

Asthma also often flies under the radar, not just for doctors but for patients too. About 1 in 5 patients underestimate the severity of their asthma, while many overestimate their control. Awareness of red flags – such as frequent flare-ups or poor symptom control – is critical. Daytime symptoms more than twice a week, nighttime symptoms more than twice a month, frequent use of emergency inhalers or limited physical activities all signal risks.

These warning signs can be controlled in nearly 95% of patients with minimal medications, proper inhaler technique, addressing environmental triggers and treating related conditions such as acid reflux.

For 5% to 10% of patients with severe or hard-to-treat asthma, close monitoring and specialist care are essential.

Specialist visits allow a thorough review of a patient’s history, including long-term steroid use, and help identify low-hanging fruit such as poor inhaler technique, lifestyle factors, coexisting conditions or diseases that mimic asthma.

Identifying symptoms early can mitigate health risks

New tools, such as blood tests and breath analyses, can measure airway inflammation and even predict flare-ups, treatment failures or lung function loss. While not yet widely used, these tools are the first giant leap toward proactive care, identifying problems before they take a serious toll. For example, patients with signals of inflammation in both blood and breath tests are at a much higher risk of future loss of lung function and exacerbations than their counterparts without these signals.

Another major advance is targeted therapies called biologics. These shots are usually administered under the skin by patients at home. They help control inflammation caused by asthma. In carefully selected patients, biologics can reduce flare-ups and hospitalizations, improve lung function, enhance quality of life and lower the need for oral steroids.

Many federally sponsored insurance programs now include certain biologics on their list of covered prescription drugs. However, actual approval and patient out-of-pocket costs can vary widely.

Advancing a new vision for asthma care

Michiganders would benefit from raising their awareness of asthma, not just because asthma is common here but because our environment is changing fast. Events like the 2023 Canadian wildfires show that the air we breathe is dynamic and unpredictable.

In my view, it is imperative to adopt a proactive approach that uses commonsense measures, promotes awareness, applies evidence-based practice and identifies at-risk people early. Achieving this vision requires addressing real-world challenges such as research gaps, costs and access to care.

Asthma is not just a personal health issue, it is a public health priority. My patients are impacted not only by lifestyle choices but also by factors outside of their control – factors such as drug costs, insurance plans, environmental changes and access to care.