# Primary care provider referral patterns and awareness of biologic therapy for uncontrolled asthma

## TL;DR

Most primary care providers in the US delay referring asthma patients to specialists and are unfamiliar with biologic therapies that can reduce asthma exacerbations.

## Contribution

This study identifies gaps in PCP knowledge and referral practices regarding asthma biologics and laboratory testing.

## Key findings

- 51.4% of PCPs refer uncontrolled asthma patients to specialists after ≥3 annual exacerbations.
- 32.8% of PCPs are unfamiliar with asthma biologic therapy.
- 72.1% of PCPs do not routinely use laboratory tests in asthma management.

## Abstract

Asthma is a chronic airway disease associated with substantial morbidity. Most patients with uncontrolled asthma in the United States are managed by primary care providers (PCPs) and not by asthma specialists who are frequently updated on asthma treatment advances, including biologics, which decrease asthma exacerbation rates.

We sought to investigate PCP referral patterns to asthma specialists, their familiarity with asthma biologic therapies, and the use of laboratory tests in asthma management.

This was a cross-sectional survey study administered to PCPs in 47 US states. Respondent characteristics were analyzed using descriptive statistics. Bivariate analyses were conducted to examine associations between respondent characteristics and outcomes, with variables significant at P < .05 included in multivariable models.

The survey was completed by 404 PCPs, of whom 51.4% referred patients with uncontrolled asthma to a specialist after ≥3 annual exacerbations, 32.8% were unfamiliar with asthma biologic therapy, and 72.1% did not routinely order laboratory tests to guide management. PCPs who manage patients with asthma more frequently were more likely to be familiar with asthma biologics (odds ratio = 1.74, 95% CI 1.42-1.88, P = .001) and more likely to use laboratory data to aid in management (OR = 5.41, 95% CI 2.72-10.77, P < .001).

Most PCPs delay specialist referrals until patients experience ≥3 annual asthma exacerbations and do not use laboratory tests in asthma management, and many are unfamiliar with asthma biologics. Enhancing communication and education between PCPs and specialists on asthma therapies may help reduce asthma exacerbations.