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Less than half of severe asthma patients receive specialist care

Published: June 17, 2021

Asthma affects 25 million individuals in the United States (US). Although patients with severe asthma make up only a small segment (5-10%) of the total asthma population, they disproportionally account for a large proportion of asthma exacerbations, hospitalizations, and other health care utilization. The 2007 guidelines of the US National Heart, Lung, and Blood Institute recommend patients with severe asthma be referred to an asthma specialist (allergist/immunologist or pulmonologist) for systematic assessment or co-management. Better understanding of the real-world receipt of asthma specialist care among US patients with severe asthma can help inform the unmet needs in asthma care.

In a US retrospective, observational study published in The Journal of Allergy and Clinical Immunology: In Practice, Most et al. identified a cohort of 54,332 patients with severe asthma who were 6 years of age and older between 2015 and 2017 in the IQVIA PharMetrics® Plus database of commercially insured individuals. The authors quantified the frequency of asthma specialist visits over two years, examined patient characteristics that were associated with specialist visits, and described patient outcomes following specialist care in a subgroup of 5,988 patients who had their first observed asthma specialist visit during the study period.

The authors found that only 38.2% of patients with severe asthma saw an asthma specialist at least once within a two-year period. Among patients who had at least one specialist visit, the majority (62.3%) visited an allergist/immunologist, 28.6% visited a pulmonologist, and 9.1% visited both specialties. The greatest predictors of having an asthma specialist visit were a higher number of prior asthma exacerbations, younger age, and having severe asthma identified in a more recent calendar year. Patients with non-respiratory comorbidities, those 65 years and older, and male patients were less likely to receive specialist care. In the year following the first observed asthma specialist visit, the authors also observed significantly greater usage of asthma controller medications and biologics. Asthma exacerbations (37.7% versus 49.4%), hospitalizations (10.1% versus 8.2%), emergency department visits (34.8% versus 28.1%), and rescue inhaler use (92.7% versus 81.7%) were significantly less frequent in the year following the first observed specialist visit. In summary, the results suggest that specialist care for severe asthma is underutilized, with only four in 10 patients receiving care within a two-year period. Efforts should be made to increase specialist involvement in the care of patients living with severe asthma by identifying and removing critical barriers to referral and receipt of specialist 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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