Impact of Language Barriers on Pulmonary Function and Asthma Control.

Abstract

Background: Asthma disproportionately affects non-English-speaking populations, with language barriers contributing to worse health outcomes, including increased emergency department visits and hospitalizations. Addressing these disparities requires culturally and linguistically appropriate care.

Objective: This study evaluated the impact of language barriers on asthma control and pulmonary function testing.

Methods: A retrospective cohort study analyzed data from 28,346 patients aged 12 and older with asthma. Patients were categorized as English- or non-English-speaking based on language preference in electronic health records. Asthma outcomes were measured using the Asthma Control Test (ACT), Pulmonary Function Tests (PFT), and healthcare utilization patterns (outpatient visits, ER visits, and hospitalizations). Atopy was assessed using skin prick tests or specific IgE when available.

Results: English-speaking patients were more likely to have ACT scores (OR 1.43, 95% CI [1.11-1.83]) and PFTs (OR 1.75, 95% CI [1.31-2.31]) recorded in their health records. Non-English-speaking patients were more likely to have uncontrolled asthma (ACT ≤20: OR 4.3, 95% CI [2.61-7.09]) and lower FEV1 percent predicted (mean = 70.7 vs. 78.4, p = 0.007). Non-English speakers were less likely to have ambulatory visits (OR 2.00, 95% CI [1.56-2.57]) but more likely to seek care in ERs (OR 1.36, 95% CI [1.17-1.58]). Hospitalization rates were similar between groups. Atopy prevalence was similar.

Conclusion: Language barriers significantly impact asthma management, leading to worse outcomes in patients with limited English proficiency. Health systems should prioritize professional interpreters, bilingual education, and technological solutions (e.g., AI-based translation models) to reduce disparities. Future research should assess the long-term effects of language-concordant interventions.