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Allergists, pulmonologists and asthma guidelines: what are they doing?

Published online: April 25, 2020

Use of practice guidelines has been associated with improved asthma care and reduced asthma morbidity. Asthma specialists including allergists and pulmonologists consistently demonstrate better patient asthma outcomes compared to generalists. The reasons for improved patient outcomes are not known but may include higher adherence to the guidelines, specialty training and experience, differences in patient populations or a combination of these factors. Yet, little is known whether guideline agreement and adoption differ between allergists and pulmonologists at the national level.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Cloutier and colleagues assessed similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the 2007 National Asthma Education and Prevention Program’s (NAEPP) Third Expert Panel Report (EPR-3). They evaluated variations in self-reported clinician agreement and self-efficacy (defined as confidence), as well as adherence with the evidence-based EPR-3 recommendations, using recently released data from the 2012 National Asthma Survey of Physicians (NAS). The NAS was a one-time questionnaire supplement to the National Center for Health Statistic’s National Ambulatory Medical Care Survey and was administered to a nationally representative sample of asthma care providers. Responses from a total of 134 allergists and 99 pulmonologists in the cornerstone areas of asthma assessment and monitoring, patient education, environmental control and medication treatment were analyzed.

Agreement and self-efficacy to implement guidelines did not differ between allergists and pulmonologists. Both groups almost always assessed asthma control, assessed school/work asthma triggers and endorsed inhaled corticosteroid use. Repeated assessment of inhaler technique, use of asthma action/treatment plans and spirometry were reported less frequently and offer opportunities for improvement. Compared to pulmonologists, allergists were more likely to perform spirometry, ask about nighttime awakening and emergency department or urgent care visits, assess home triggers and perform allergy testing. These differences in guideline adherence between allergists and pulmonologists were mostly explained by differences in practice-specific characteristics such as patient population. Improving understanding of factors and clinical decision-making underlying variations in guideline adherence and differences between specialist groups could better inform guideline recommendations and a personalized approach to asthma care.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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