Q:

2/14/2012
Asthma Outcome with Allergist Treatment - I recall there were published studies over the past decade or so documenting that care of asthmatics by a board certified allergist, as compared with generalists or pulmonologists, led to improved disease control and decreased cost. Try as I might, I have been unable to uncover this data using Medline.

 

I have some colleagues who insist that all asthmatics should be followed by a pulmonologist rather than an allergist. I would appreciate any facts you can provide that may help convince them that allergists are equally competent in providing asthma care. Thank you.

A:

Thank you for your inquiry.

There are quite a number of articles that have compared asthma care offered by Allergy and Pulmonology specialists versus Primary Care specialists. I have copied for you below a link to one of these articles which appeared in the Archives of Medicine, a general medicine journal, a copy of an abstract which appeared in the Journal of Allergy and Clinical Immunology, and a copy of an abstract which appeared in the journal Pediatrics. Each of these of course will give you a bibliography from which you can draw further information.

In general, these studies have found better outcomes when care is rendered by an allergist or pulmonologist. I am personally unaware of any study directly comparing allergists versus pulmonologists that have found significant differences in outcome, but close reading of the bibliography in full may reveal some information in this regard.

Finally, a convenient way to get a complete bibliography and abstracts of some of the key articles is to contact the American College of Allergy, Asthma, and Immunology. They printed a supplement which was, to my recollection, mailed to all of their members. It is entitled "Asthma Management and the Allergist: Better Outcomes at Lower Costs". There are well over 30 briefly abstracted articles dealing with outcome and cost studies, and a total of 47 references; many of these comparing care between primary care specialists and allergists. I am not sure whether this is still in print or whether copies have been saved, but you can contact the College in this regard to see if further copies are available. It was published and mailed in 2009.

Thank you again for your inquiry and we hope this response is helpful to you.

http://archinte.ama-assn.org/cgi/reprint/161/21/2554.pdf

The Journal of Allergy and Clinical Immunology
Volume 116, Issue 6 , Pages 1307-1313, December 2005
Improved asthma outcomes from allergy specialist care: A population-based cross-sectional analysis
Objective: We sought to compare patient-based and medical utilization outcomes in randomly selected asthmatic patients cared for by allergists versus primary care providers.
Methods: A random sample of 3568 patients enrolled in a staff model health maintenance organization who were given diagnoses of persistent asthma completed surveys. Of these participants, 1679 (47.1%) identified a primary care provider as their regular source of asthma care, 884 (24.8%) identified an allergist, 693 (19.4%) reported no regular source of asthma care, and 195 (5.5%) identified a pulmonologist. Validated quality of life, control, severity, patient satisfaction, and self-management knowledge tools and linked administrative data that captured medication use were compared between groups, adjusting for demographics and baseline hospital and corticosteroid use.
Results: Compared with those followed by primary care providers, patients of allergists reported significantly higher (P < .001) generic physical and asthma-specific quality of life, less asthma control problems, less severe symptoms, higher satisfaction with care, and greater self-management knowledge. Patients of allergists were less likely than patients of primary care providers to require an asthma hospitalization (odds ratio, 0.45) or unscheduled visit (odds ratio, 0.71) and to overuse â-agonists (odds ratio, 0.47) and were more likely to receive inhaled steroids (odds ratio, 1.81) during their past year.
Conclusions: Allergist care is associated with a wide range of improved outcomes in asthmatic patients compared with care provided by primary care providers.

Comparison of Quality of Care by Specialist and Generalist Physicians as Usual Source of Asthma Care for Children, Pediatrics Vol. 108 No. 2 August 1, 2001, pp. 432 -437
(doi: 10.1542/peds.108.2.432)
Abstract
Objective: To determine whether care for children was more consistent with national asthma guidelines when a specialist rather than a generalist was the usual source of asthma care.
Design. Cross-sectional survey.
Setting: Two large managed care organizations in the United States.
Participants: A total of 260 parents of children with asthma.
Interventions: None.
Main Outcome Measures: Parent reports of the physician primarily responsible for asthma care (specialist, generalist, or both equally) and whom they would call (specialist or generalist) for questions about asthma care were used to define usual source of care. We assessed consistency of care with 1997 National Asthma Education and Prevention Program guidelines using 11 indicators in 4 domains of asthma care: patient education, control of factors contributing to asthma symptoms, periodic physiologic assessment and monitoring, and proper use of medications.
Results: In all 4 domains, care was more likely to be consistent with guidelines when specialists were the usual source of care. These differences remained after adjustment for symptom severity, recent care encounters, and parent demographics. Greatest differences for specialist versus generalist management were for use of controller medications (odds ratio [OR] 6.7; 95% confidence interval [CI]: 1.5-30.4), ever having a pulmonary function test (OR 6.5; 95% CI: 2.4-18.1), and having been told about asthma triggers and how to avoid them (OR 5.9; 95% CI: 1.3-26.2).
Conclusions: In these managed care organizations, asthma care in children was more likely to be consistent with national guidelines when a specialist was the primary provider. Greater use of specialists or altering generalist physicians' care may improve the degree to which the care of children with asthma is consistent with national guidelines.

Sincerely,
Phil Lieberman, M.D.

Close-up of pine tree branches in Winter Close-up of pine tree branches in Winter