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


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.


CONCLUSIONS
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.
Chen
Hubert
H
Division of Pulmonary and Critical Care Medicine, University of California San Francisco, CA, USA. hubert.chen@ucsf.edu
Johnson
Charles A
CA
Haselkorn
Tmirah
T
Lee
June H
JH
Israel
Elliot
E
D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000453:epidemiology*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D017063:Outcome Assessment, Health Care; D015272:Pulmonary Medicine / Q000379:methods*; D012189:Retrospective Studies; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology
D018927:Anti-Asthmatic Agents