To determine the nature and extent to which asthma characteristics and management differ between allergy and pulmonary subspecialists.
We used baseline data from 3,342 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 healthcare utilization were collected via study coordinator-administered interviews and self-administered validated questionnaires.
In the TENOR study, 2,407 (72%) patients were treated by allergists and 935 (28%) by pulmonologists. Patients treated by pulmonologists were more likely to be black, less educated, and have lower incomes than those treated by allergists. Pulmonary patients had more severe asthma as indicated by physician-assessment, GINA classification, lung function, and number of asthma control problems. Regular use of a short-acting beta-agonist and systemic corticosteroid use was also higher among pulmonary patients than allergy patients, consistent with greater asthma severity. Although evidence of allergic disease was prevalent in both types of patients, allergist treated patients 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 healthcare utilization for asthma in the past 3 months.
In general, asthma patients treated by pulmonologists are of lower socioeconomic status, have more severe disease, require more medication, and report greater healthcare utilization than those treated by allergists.