Many Primary Care Docs Unfamiliar With Biologics for Asthma

ANAHEIM, Calif. — Many primary care physicians (PCPs) remain unfamiliar with biologic therapy options for uncontrolled asthma, which impacted the rate at which they referred patients to an asthma specialist, a survey-based descriptive study showed.

Of the PCPs surveyed, 42% reported that they were not familiar with biologics, while 45% said they were somewhat familiar and 12% were very familiar, said Bijalben R. Patel, MD, of the University of South Florida Morsani College of Medicine in Tampa, during the American College of Allergy, Asthma & Immunology annual meeting.

This lack of familiarity also extended to knowledge of lab testing requirements, with 82% of PCPs not requesting lab work for asthma patients and 90% not utilizing absolute eosinophil count as a measurement of asthma management and treatment, Patel noted.

In a press release, co-author Juan Carlos Cardet, MD, MPH, also of the University of South Florida Morsani College of Medicine, said that “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.”

“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,” he added.

Notably, 77% of the PCPs surveyed reported referring a patient to an asthma specialist only after that patient experienced two or more asthma exacerbations a year (47% after two exacerbations, 30% after three or more exacerbations), while 15% referred patients after one exacerbation within the past year and 8% referred prior to any exacerbation.

“The majority of [PCPs] wait until two or more exacerbations, and at that point we kind of categorize the patient as uncontrolled refractory asthma or exacerbation-prone asthma,” Patel told MedPage Today.

“The reason we’re concerned is because they’re going to likely keep receiving oral corticosteroids and [have] those side effects,” she said. “If we increase our communications with [PCPs] and have more education, and if patients qualify earlier, then we can start them on biologics or other treatments to avoid those side effects.”

More consistent exposure to patients with asthma (P=0.020), as well as more frequent PCP referral to an asthma specialist (P=0.029), appeared to significantly increase the provider’s likelihood of requesting lab work to assist in managing asthma.

However, the proportions of PCPs unfamiliar with biologics and their associated eligibility criteria for patients did not vary based on the number of asthma patients seen by that PCP per month. Furthermore, the frequency of PCP referrals to a specialist did not change familiarity with biologics or associated eligibility criteria.

For this study, a total of 85 PCPs, both resident and attending physicians, within family medicine, pediatric, and internal medicine departments received a REDCap survey via email and provided responses.

Patel noted that some biologic treatments are relatively new in their various approved uses for different patient populations, which may be a reason for some of the unfamiliarity reported by PCPs.

“Most patients with asthma are managed by primary care physicians and not by an asthma specialist,” Patel noted. “This is important because, routinely, it is the specialists who are more frequently updated on asthma treatment advances, including biologic therapy, which is shown to decrease exacerbation rates.”

Stressing the importance of communication and continuous education on new asthma treatments, Patel told MedPage Today, “I think it’s important to note that a lot of these therapies are fairly recent. It’s not something we were taught in medical school or residency — these are new updates that have come out. That’s why I focus on the education part more, because that is how we bridge this gap.”

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