Use of National Asthma Guidelines by Allergists and Pulmonologists: A National Survey.

Abstract Background Little is known about specialist-specific variations in guideline agreement and adoption. Objective To assess similarities and differences between allergists and pulmonologists in adherence to cornerstone components of the National Asthma Education and Prevention Program’s Third Expert Panel Report (EPR-3). Methods Self-reported guideline agreement, self-efficacy and adherence were assessed in allergists (n=134) and pulmonologists (n=99) in the 2012 National Asthma Survey of Physicians. Multivariate models were used to assess if physician and practice characteristics explained bivariate associations between specialty and “almost always” adhering to recommendations (i.e., ≥75% of the time). Results Allergists and pulmonologists reported high guideline self-efficacy and moderate guideline agreement. Both groups “almost always” assessed asthma control (66.2%, SE 4.3), assessed school/work asthma triggers (71.3%, SE 3.9), and endorsed inhaled corticosteroids use (95.5%, SE 2.0). Repeated assessment of inhaler technique, use of asthma action/treatment plans and spirometry were lower (39.7%, SE 4.0, 30.6%, SE 3.6, 44.7%, SE 4.1, respectively). Compared to pulmonologists, more allergists almost always performed spirometry (56.6% vs 38.6%, P=.06), asked about nighttime awakening (91.9% vs 76.5%, P=.03) and ED visits (92.2% vs 76.5%, P=0.03), assessed home triggers (70.5% vs 52.6%, P=.06) and performed allergy testing (61.8% vs 21.3%, P Conclusions Overall, allergists and pulmonologists adhere to the asthma guidelines with notable exceptions, including asthma action plan use and inhaler technique assessment. Recommendations with low implementation offer opportunities for further exploration and could serve as targets for increasing guideline uptake.