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. 2021 Oct;9(10):3662-3671.e1.
doi: 10.1016/j.jaip.2021.05.003. Epub 2021 Jun 17.

Real-World Assessment of Asthma Specialist Visits Among U.S. Patients with Severe Asthma

Jessica F Most  1 , Christopher S Ambrose  2 , Yen Chung  3 , James L Kreindler  3 , Aimee Near  4 , Stephen Brunton  5 , Yao Cao  4 , Huan Huang  4 , Xiaohui Zhao  6
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Free article

Real-World Assessment of Asthma Specialist Visits Among U.S. Patients with Severe Asthma

Jessica F Most et al. J Allergy Clin Immunol Pract. 2021 Oct.
Free article

Abstract

Background: U.S. guidelines recommend that patients with severe asthma be referred to specialists (allergists/immunologists or pulmonologists) for systematic assessment or comanagement; however, contemporary, real-world data on the frequency and impact of specialist care among U.S. severe asthma patients are lacking.

Objectives: To quantify the frequency of asthma specialist visits among U.S. patients with severe asthma, identify patient demographic and clinical characteristics associated with specialist visits and describe health outcomes following specialist care.

Methods: Severe asthma patients aged 6 years or older were identified between January 1, 2015, and December 31, 2017, in the IQVIA PharMetrics® Plus database of commercially insured individuals, based on Healthcare Effectiveness Data and Information Set (HEDIS) criteria and Global Initiative for Asthma (GINA) step 4 or 5 treatment regimens. The frequency of asthma specialist (allergist/immunologist or pulmonologist) visits was described over 2 years. Patient characteristics associated with having 1 or more specialist visits were analyzed using multivariate regressions. Asthma exacerbations and health care resource utilization before and after specialist visit were compared.

Results: Of 54,332 patients identified, 38.2% had 1 or more specialist visits over 2 years. Patient characteristics predictive of specialist visits were asthma exacerbation frequency, younger age, and allergy/respiratory comorbidity burden (all P < .001). Among patients with 1 or more specialist visits, a lower prevalence of asthma exacerbations and rescue inhaler use was observed following the first observed specialist visit.

Conclusions: Specialist care was observed in fewer than half of U.S. patients with severe asthma and was least frequent among older adult patients and those with more nonrespiratory comorbidities. Increased specialist involvement in managing severe asthma may help improve care and patient outcomes.

Keywords: Allergists/immunologists; Asthma exacerbation; Global Initiative for Asthma; Health care resource utilization; Pulmonologists; Severe asthma; Specialist visits.

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