Researchers and doctors are beginning to 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 .

In Michigan, . 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 , which is ranked No. 1 in the U.S. as the – based on prevalence, emergency department visits and deaths.

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

Between 2019 and 2023, Detroiters were 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 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 , 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 . 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, can happen even in those labeled as having “mild” asthma. A seemingly manageable episode can , 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 . These , are serious.

Patients who have frequent exacerbations are more likely to have future flare-ups and face long-term risks such as or .

Even the medicines used to treat flare-ups carry risks. Just two courses of oral steroids per year can raise the risk of . It is also important to note that poorly controlled asthma or regularly needing higher-dosage inhalers can lead to .

Many patients also for routine asthma care. This is often due to poor knowledge about asthma, high medication costs, 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 , waiting for symptoms to spiral downward and not really focused on addressing risk. Patients with warning signs often go unnoticed or receive treatments that . 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 . Detroiters are exposed to both year-round allergens – such as and indoor molds – as well as seasonal allergens such as .

Allergen mitigation was once a major strategy for managing asthma and often thought of as a stand-alone intervention. But 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 .

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. underestimate the severity of their asthma, while many overestimate their control. Awareness of – 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 with minimal medications, proper inhaler technique, addressing environmental triggers and treating related conditions such as acid reflux.

For 5% to 10% of patients with , 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

, such as and , 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 . These shots are usually administered under the skin by patients at home. They help control inflammation caused by asthma. In , 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 . Events like the 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 . 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.