ANAHEIM, California — Patients with uncontrolled asthma are seen more often by primary care providers (PCPs) than by allergists, but a survey has found that 42% of PCPs are unfamiliar with the biologics that have markedly improved asthma treatment options over the past two decades.

Bijal Patel, MD, with the Department of Internal Medicine, University of South Florida (USF) Morsani College of Medicine in Tampa, told Medscape Medical News that in addition to the considerable lack of knowledge of biologics in primary care, she was surprised that 77% of survey participants stated they only referred patients to specialists after two or more exacerbations.

“This is important because these patients are considered to have exacerbation-prone asthma which should be managed by specialists,” she said.

She said that being “unfamiliar” with biologics meant that the healthcare provider may have heard of biologics but did not know the various types, initiation criteria, or side effects.

The researchers administered a REDCap (Research Electronic Data Capture) survey by email to primary care attending and resident physicians in the Departments of Internal Medicine, Family Medicine, and Pediatrics, and 85 responded. Responses were compared using Chi-square tests.

Patel presented the results of the survey (abstract P110) on November 10, 2023 at the American College of Allergy, Asthma & Immunology (ACAAI) Annual Meeting; view the poster here.

82% Do Not Order Labs

Familiarity did not vary in primary care with number of patients with asthma seen per month, the researchers noted.

“Also, the frequency of PCP referrals to a specialist did not change familiarity with biologics (p=0.260) or eligibility criteria (p=0.393),” the researchers state.

In addition, they found that 82% of those surveyed do not order labs, and 90% do not use absolute eosinophil count to guide care.

Patel explained that lab work such as obtaining immunoglobulin E levels and a complete blood count with a differential and examining the absolute eosinophil count help identify patients who are at high risk for future exacerbation and also treatable phenotypic traits, which can be targeted with biologic therapy. 

Angela Duff Hogan, MD, vice chair of the ACAAI Asthma Committee and professor of pediatrics at Eastern Virginia Medical School in Norfolk, told Medscape Medical News that she finds the delay on referrals the most concerning finding in the survey results.

“I’m not as concerned they are not obtaining labs,” said Hogan, who was not part of the study. “The specialist can do that. It’s more concerning they wait so long to refer a patient with poorly controlled asthma. We know that asthma patients treated by an allergist have better asthma control, better quality of life, and reduced healthcare costs.”

Asthma Specialists ‘Need Better Marketing’

Hogan said that the results show the need for more studies to demonstrate that asthma specialists can improve outcomes and reduce healthcare costs.

“Objective data is more convincing than subjective data,” she noted. “As a specialty, we need to disseminate more information about asthma management, the “new” asthma guidelines, SMART/MART therapy, and the importance of biologicals in asthma. We need better marketing as a specialty in asthma care.”

Patel said that their goal with the study is to raise awareness about the available asthma biologic therapies, which have been improving care for two decades.

“The results of the survey point to the need to improve the communication between primary care physicians and asthma care specialists, including regarding use of biologics,” senior author Juan Carlos Cardet, MD, MPH, also an allergy specialist at USF, added in a press release. “Biologics have become an important tool in the treatment of asthma and other allergic diseases such as atopic dermatitis (eczema), chronic rhinosinusitis with nasal polyps and eosinophilic esophagitis, and can prevent substantial ill results from occurring in patients who are eligible for them.”

Authors and Dr Hogan disclosed no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @MLfrellick.
 

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