Subspecialty differences in asthma characteristics and management.

Full Abstract

OBJECTIVE:
To determine the nature and extent to which asthma characteristics and management differ between allergy and pulmonary subspecialists.

PATIENTS AND METHODS:
We used baseline data from 3342 adults enrolled in The Epidemiology and Natural History of Asthma:
Outcomes and Treatment Regimens (TENOR) study, a multicenter, observational cohort recruited from subspecialty practices across the United States. Information on physician subspecialty, asthma history, allergic status, lung function, medication use, and recent health care use was collected from January 1, 2001, through April 30, 2004, via study coordinator-administered interviews and self-administered validated questionnaires.

RESULTS:
In the TENOR study, 2407 patients (72%) were treated by allergists and 935 (28%) by pulmonologists. Patients treated by pulmonologists were more likely to be black, be less educated, and have lower incomes than those treated by allergists. Pulmonary patients had more severe asthma as indicated by physician assessment, Global Initiative for Asthma classification, lung function, and number of asthma control problems. Regular use of a short-acting beta-agonist and systemic corticosteroid use were also higher among pulmonologist-treated patients than allergist-treated patients, consistent with greater asthma severity. Although evidence of allergic disease was prevalent in both types of patients, those treated by an allergist were more likely to receive skin testing or immunotherapy. In multivariate analyses adjusted for demographic differences, patients treated by pulmonologists were more likely to report health care use for asthma in the past 3 months.

CONCLUSION:
In general, asthma patients treated by pulmonologists have lower socioeconomic status, have more severe disease, require more medication, and report greater health care use than those treated by allergists.

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Author information

Author/s: Chen, Hubert (H); Johnson, Charles A (CA); Haselkorn, Tmirah (T); Lee, June H (JH); Israel, Elliot (E);

Affiliation: Division of Pulmonary and Critical Care Medicine, University of California San Francisco, CA, USA. hubert.chen(-atsign-)ucsf.edu

Grants: K23 HL086585 (Agency:United States NHLBI)

Journal and publication information

Publication Type: Comparative Study; Journal Article; Multicenter Study; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't

Journal: Mayo Clinic proceedings. Mayo Clinic (Mayo Clin Proc), published in United States. (Language: eng)

Reference: 2008-Jul; vol 83 (issue 7) : pp 786-93

Dates: Created 2008/07/10; Completed 2008/07/22;

PMID: 18613995, status: MEDLINE (last retrieval date: 11/6/2008)

Sourced from the National Library of Medicine. Abstract text and other information may be subject to copyright.

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MeSH headings (categories)

This article was linked to the MESH Headings shown below.

Anti-Asthmatic Agents - therapeutic use
Asthma - drug therapy; epidemiology
Clinical Competence - standards
Female
Follow-Up Studies
Humans
Male

Middle Aged
Morbidity - trends
Outcome Assessment (Health Care)
Pulmonary Disease (Specialty) - methods
Questionnaires
Retrospective Studies
United States - epidemiology

Associated Chemicals: Anti-Asthmatic Agents (0)

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