Over 24 million (7.8%) individuals in the United States currently have asthma (1). While many minority and low-income populations are disproportionately affected by asthma, the underlying reasons for disparities are varied and incompletely understood (2–6). To address asthma disparities, comprehensive and cross-cutting approaches are most effective (6–8). Healthcare provider communications integrating disease education, medication management, and patient support resources are important for improving asthma control and decreasing asthma morbidity (6–9).

The patient–provider partnership provides both a foundation for effective asthma care and an opportunity to optimize asthma control as described in Healthy People 2020. The Healthy People 2020 objective for respiratory disease (RD-7.7) aims to increase the proportion of persons with current asthma whose doctor assessed their asthma control at the last visit according to National Asthma Education and Prevention Program (NAEPP) guidelines (10–11). Using national indicators created to examine health communications, we explored demographic differences in provider assessments of asthma control among persons with current asthma.

In 2013, 3,684 NHIS survey respondents reported having current asthma, representing an estimated 7.3% of the U.S. population. Characteristics of persons with current asthma are shown in Table 1 and national estimates are displayed as weighted prevalence percentages. Groups with the highest asthma prevalence were females (8.3%; 95% CI = 7.9–8.8), children (8.3%; 95% CI = 7.8–8.9), Blacks (non-Hispanic) (9.9%; 95% CI = 9.1–10.8), Puerto Ricans (14.6%; 95% CI = 11.8–17.9), and persons with income status <100% FPL (11.0%; 95% CI = 10.1–12.0).

In terms of asthma morbidity, Puerto Ricans and Blacks (non-Hispanic) had the highest report of an emergency room or urgent care center visit during the past 12 months at 24.9% (95% CI = 17.5–34.2) and 20.5% (95% CI = 17.2–24.2), respectively. During the past 12 months, Other-Hispanics had the highest report of an episode of asthma or an asthma attack at 58.0% (95% CI = 48.0–67.4). Overall, among persons with current asthma, over half (57.7%, 95% CI = 55.5–59.8) reported having a routine healthcare visit for asthma in the last 12 months.

Table 2 shows weighted prevalence of asthma control assessments by sex, age, race/ethnicity, and income status. Assessments of asthma control indicators at last healthcare visit for asthma symptoms, quick-relief inhaler use, and activity limitations were reported by 55.4% (95% CI = 53.1–57.7), 59.1% (95% CI = 57.1–61.0), and 41.5% (95% CI = 39.5–43.6) of respondents, respectively. Healthcare providers asked about one or more of the asthma control indicators among most survey respondents with current asthma [66.4% (95% CI = 64.4–68.4)].

Table 3 shows PRs for each of the asthma control assessments across demographic categories. After adjusting for sex, age, and income status, blacks (non-Hispanic) (PR = 1.11; 95% CI = 1.03–1.20), Puerto Ricans (1.23; 95% CI = 1.08–1.40), and other Hispanics (1.18; 95% CI = 1.05–1.32) were more frequently asked at least one of the three asthma-control indicators compared to non-Hispanic whites (Figure 1). Healthcare providers asked about the three asthma control indicators when assessing children more often than adults. After adjusting for sex, race/ethnicity, and income status, children were more frequently assessed by providers for asthma symptoms (1.20; 95% CI = 1.10–1.30), quick-relief inhaler use (1.10; 95% CI = 1.02–1.19), and limitations in daily activities from asthma (1.25; 95% CI = 1.11–1.41) when compared to adults. Differences in prevalence were not identified by sex or income status.

From this study, we find that many persons with current asthma (66%) were asked about at least one of the key indicators of asthma control, including symptom frequency, rescue inhaler use, or activity limitations, during visits with a healthcare provider. While the majority of persons with current asthma were asked about at least one key indicator of asthma control, about one-third were not. This study provides a baseline measurement to compare asthma control assessment trends in the future. Our study provides insightful information on patient-provider communications regarding asthma control and Healthy People 2020 objective RD-7.7. Notably, our findings indicate that groups that typically face higher asthma prevalence and morbidity, including children, non-Hispanic blacks, Puerto Ricans, and other Hispanic minorities, are asked more often about indicators of asthma control by their healthcare provider. This finding may reflect healthcare provider awareness of and efforts to specifically target asthma control communications to at-risk groups known to face an increased burden of asthma as encouraged by the NAEPP (8,11).

Our study provides insights into asthma control communications between healthcare providers and their patients across multiple demographic characteristics. Our findings in children as well as racial/ethnic minorities suggest that groups currently with higher asthma prevalence and morbidity were more frequently asked by providers about asthma control during routine medical visits. As patient–provider communications are critical to disease monitoring and management, decreasing barriers to asthma control, and reducing asthma disparities, this study demonstrates that clinicians are assessing asthma control measures among most persons with current asthma and, ideally, improving asthma outcomes.