African Americans & Health: Focus On Lung Disease (Part 2 in a Series)

African Americans are disproportionately affected by diseases that affect the respiratory system. When it comes to lung cancer, sarcoidosis, and asthma, statistics are quite revealing. African Americans are:

• More likely to get malignant lung tumors than any other population group in the U.S.
• Three times more likely to develop sarcoidosis than Caucasians in the U.S.
• Three times more likely to die from asthma than other groups

Lung Carcinoma and African Americans

This is the second most common cancer in African Americans. African American men are 37% more likely to be affected by the disease and 22% more likely to die from it than Caucasian men—even when accounting for smoking rates. African American women, on the other hand, develop the condition at about the same rate as Caucasian women.

A variety of factors can increase risk for the disease:

• Smoking: This is the most important risk factor associated with malignancies of the lung and the leading cause of death from this condition. Vaping and marijuana use also affect the lungs. Any time you inhale anything into your lungs, there’s a potential for damage.
• Second- and Third-Hand Smoke: According to the American Lung Association, African Americans are exposed to more second-hand smoke than other groups. Third-hand smoke refers to the oils and fumes that can remain on a smoker’s clothing and skin and affect other household members and close contacts. There’s evidence that this exposure may increase risk as well.
• Family History: If you have a first-degree relative who has had lung tumors, that’s a risk.
• Environmental Factors: You may have a higher risk depending on your exposure to various air pollutants and radon, which is a colorless, odorless radioactive gas found in higher concentrations in some homes. Radon is the second leading cause of malignancies of the lungs.
• Primary Cancers: Having cancer in other parts of your body increases the risk of lung tumors. 

At MedStar Washington Hospital Center, we target tumors on an individual basis through programs such as Lung Cancer Screening, Smoking Cessation Counseling, and Thoracic Oncology services. Over the last five to ten years, medicine has gained a better understanding of molecular markers and immunotherapies in lung cancer treatment. It’s become more important to know the tumor type and genetics involved so we can choose an appropriate therapy. Regardless of your race, gender, or age, we look at the genetics of each patient’s individual tumor type because that helps us understand which therapy to choose.

Sarcoidosis and African Americans

Sarcoidosis is an inflammatory disease that can develop when the immune system creates an overgrowth of cells called granulomas in various organs throughout the body. We see it commonly in the lungs and lymph nodes, but it can occur anywhere in the body—eyes, nerves, heart, gut, liver, kidneys, even on your skin.

In the United States, African Americans are three times more likely to develop the disease and 16 times more likely to die from it than Caucasians. African American women have the highest incidence in the nation and tend to be more severely affected.

This increased rate of death in the African American population is due to the disease affecting multiple organs. Unfortunately, the reason for more extensive disease is unknown since we haven’t pinpointed what causes sarcoidosis to begin with.

The data shows that sarcoidosis probably has a genetic component as well as an environmental component. Interestingly, during my pulmonary training in Charleston, South Carolina, which is a coastal city, we saw a lot of sarcoidosis—yet the further inland we went, the less we saw.

People with this disease can present in a multitude of ways, including shortness of breath, coughing, wheezing, palpitations, and even skin lesions. Some people may not feel anything at all depending on which organ systems are involved. It is different for everybody.

When someone is diagnosed, we perform a slew of tests to determine which organs may be involved. If the patient is short of breath, or their pulmonary function test reveals that their lung function is not what it should be, or they have other organs involved, the first-line treatment is prescribing a systemic corticosteroid like prednisone. Depending how effective this first-line treatment is, the patient may not need another treatment after a short course of these steroids.

If symptoms recur when we stop the prednisone, other immunosuppressive medications—many of which are used in rheumatology, such as methotrexate, azithromycin, and cyclophosphamide—can be used.

The good news is that sarcoidosis can be managed. Long-term damage can be minimized the sooner you seek medical care. To treat my patients, I give them breathing surveys every year. I look at their CT scans. I make sure they see their ophthalmologist and get an EKG to ensure they don’t show evidence of disease involvement in another organ.

Asthma and African Americans

Although Puerto Ricans in the United States have the highest rate and prevalence of asthma, African Americans are three times more likely to:

• Have a fatal asthma attack (especially women) than other ethnic groups
• Be hospitalized due to asthma

African American children have the highest prevalence of asthma, with roughly 13.4% compared to approximately 7.4% of Caucasian children.

The burden rests heavily on African Americans for many reasons, including genetics, socioeconomics, educational awareness, access to insurance, and exposure to allergens and other environmental factors.

Can allergies cause asthma? Yes, there certainly can be an allergic component to asthma. One of the areas currently being studied in asthma care is the body’s immune response to allergens. That means evaluating antibodies and other signs of inflammation the body has against the multiple possible allergic insults. A lot of allergists will actually treat asthma because it’s considered an allergen-mediated disease for some people. Some of the new medications for chronic and severe asthma work to modify your immune system to help it fight off allergens.

To determine if you have asthma or allergies, have a doctor listen to you breathe. Symptoms of asthma include:

• Wheezing
• Shortness of breath
• Chest tightness
• Inability to do everyday activities

The doctor may give you a breathing test called the Pulmonary Function Tests (PFT) with a methacholine challenge. During this study, we irritate your lungs to see how difficult it is to pass air through them. But this test can be negative, even in people who have asthma, which makes it difficult to diagnose definitively. Diagnosis often involves testing, clinical suspicion, and looking for other causes of respiratory symptoms. Other allergy symptoms typically involve sinusitis, rhinorrhea (runny nose), and nasal congestion.

During an asthma attack, part of the allergic response occurs within the lungs themselves. With asthma, the airways leading to the air sacs in your lungs get inflamed, so moving air in and out of those air sacs is harder. To reduce inflammation, you must either avoid your asthma triggers or use an inhaler.

Education and tracking are really important if you have been diagnosed with asthma. You can do simple tests at home such as using a peak flow meter, which is a small device that measures how well you can get air in and out of your lungs. It can reveal if your lung function is impaired or headed in the wrong direction.

Being aware of your peak expiratory flow (how fast you exhale) can help you know when to use your albuterol inhaler, call your doctor, or go to the hospital. At MedStar Washington Hospital Center, we can help you learn about the condition and work with you to create an asthma action plan. It’s about working together to learn about your body and what you can do to stay healthy.

What You Can Do

Although lung cancer, sarcoidosis, and asthma affect African Americans at higher rates, know that you can take steps to advocate for your own health. Learning about the data, understanding your family history, and assessing lifestyle choices are good first steps.

Our goal at MedStar Washington Hospital Center is to do everything we can to relieve your symptoms and improve your airways, so you can get back to your family and the activities you enjoy.