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Specific findings: Survey data were analyzed for 5,580 asthma patients covered by Health Net in California in1996. Of respondents with severe asthma, 72 percent reported having a steroid inhaler, but only 54 percentused it daily. The patients of specialists were more likely to have a steroid inhaler and peak flow meter and touse them daily. Specialists also provided more patient education on how to prevent and control asthmaattacks.Mahr TA, Evans R. Allergist influence on asthma care. Ann Allergy Asthma Immunol. 1993;71:115-120.Conclusion: Follow-up care by an allergist after hospitalization for asthma resulted in a decrease insubsequent hospitalizations and emergency room visits.Specific findings: The retrospective study compared 83 patients who received asthma follow-up care by anallergist and 40 patients who received care from a non-allergist after hospitalization. Of patients whoreceived follow-up care by an allergist, 13 percent were subsequently hospitalized, compared to 35 percenttreated by non-allergists, and 18 percent of the allergist patients had emergency room visits compared to 47percent treated by non-allergists. There were significant increases in use of all medications and devices in thegroup treated by allergists.Mitchell JB, Khatustsky G, Swigonsky NL, et al. Impact of the Oregon Health Plan on children with special healthcare needs. Pediatrics. 2001;107(4):736-743.Conclusion: Children with disabilities in managed care plans did not experience any more difficulty accessingneeded specialty care than did those without special health care needs. Children with asthma, however, hadhigher levels of unmet need.Specific findings: Three groups of children, ages 1 to 17 were sampled: 205 children with disabilities whoreceived Supplemental Security Income (SSI), 410 children with asthma and 351 children without specialhealth care needs. Almost one-fifth of the children with disabilities and one-eighth of children with asthmawere reported to be in fair or poor health. Access problems were rare, however a high proportion of childrenwith asthma reported unmet needs for specialist care and children with asthma were not eligible for the sameconsumer protections afforded SSI children by Oregon. The authors concluded that if states want to enroll allchildren with special health needs into managed care programs, they must develop mechanisms for identifyingsuch children and ensuring that they receive medically necessary services.Moller C, Dreborg S, Hosne AF, et al. Pollen immunotherapy reduces the development of asthma in children withseasonal rhinoconjunctivitis (the PAT-study). J Allergy Clin Immunol. 2002;109(2):251-256.Conclusion: Immunotherapy can reduce the development of asthma in children with seasonalrhinoconjunctivitis.Specific findings: More than 200 children ages 6 to 14 with moderate-to-severe hay fever symptoms wereenrolled in the study. At the start of the study, none of the children reported an asthma diagnosis requiringdaily treatment, however 20 percent had mild asthma symptoms during the pollen season(s). Among thosewithout asthma, the children actively treated with immunotherapy had significantly fewer asthma symptomsafter three years as evaluated by clinical diagnosis.Moore CM, Ahmed I, Mouallem R, et al. Care of asthma: allergy clinic versus emergency room. Ann AllergyAsthma Immunol. 1997;78:373-380.Conclusion: The decreased morbidity of asthma and cost of care for the allergy clinic patients, compared tothe emergency room patients, are likely due to the care given in the allergy-immunology clinic.Specific findings: Fifty emergency room patients and 25 allergy clinic patients were studied. The data showedno demographic or socioeconomic differences between the two groups. However, the clinic group hadsignificantly less nocturnal cough and sleep interruption, and fewer missed school and emergency room visits,resulting in approximate average savings of $137 per patient per year.Moy JN, Grant EN, Turner-Roan K, et al. Asthma care practices, perceptions, and beliefs of Chicago-area asthmaspecialists. Chest. 1999;116:154S-162S.Conclusion: Asthma specialists in the Chicago area are providing asthma care that is, in many ways,consistent with national guidelines. However, there are also important differences in asthma care between22
two subspecialty groups: allergists and pulmonologists. The effect of these differences on the management ofpersons with asthma is not known.Specific findings: A survey was mailed to a sample of asthma specialists (allergists or pulmonologists) in theChicago area. A total of 113 eligible surveys were returned (response rate, 72.0 percent). Ninety-nine percentof the respondents indicated they would prescribe inhaled corticosteroids for patients 5 years of age or olderwith moderate persistent asthma, and 85.5 percent would prescribe them for patients younger than 5 yearsold. The respondents reported that 71.2 percent of their patients with moderate or severe persistent asthmawere routinely given written treatment plans. The use of these plans was reported more frequently by allergiststhan pulmonologists (77.6 percent vs. 58.9 percent). Nearly half of the respondents were involved in thedevelopment of hospital-based asthma programs; fewer (14.9 percent) were involved in developing asthmaprograms for managed care organizations. A majority (63.4 percent) of the physicians had given a formalprofessional education presentation on asthma in the past year. A majority of the respondents who care forpatients under managed care contracts reported that these patients have encountered barriers to access inseeking specialty care.Nyman JA, Hillson S, Stoner T, DeVries A. Do specialists order too many tests? The case of allergists and pediatricasthma. Ann Allergy Asthma Immunol 1997;79:496-502.Conclusion: Allergists’ test-intensive practice style is cost-effective.Specific findings: A review of 1,574 pediatric asthma cases in a large health plan found that cases managed byallergists were no more costly than those managed by non-allergists, despite the fact that the allergists orderedsignificantly more tests and required more office visits than non-allergists. Patients treated by allergistsexperienced fewer hospitalizations and emergency room visits resulting in cost-savings due to improvedoutcomes and disease control.Piecoro LT, Potoski M, Talbert JC, Doherty DE. Asthma prevalence, cost, and adherence with expert guidelines onthe utilization of health care services and costs in a state Medicaid population. Health Serv Res. 2001;36(2):357-371.Conclusion: A review of asthma prevalence and utilization of health services in a Kentucky Medicaidpopulation found that widespread nonadherence to the National Asthma Education Program expert panelguidelines was associated with an increase in asthma exacerbations that resulted in hospitalizations.Specific findings: Of 530,000 Medicaid recipients, 24,365 (4.6 percent) were identified as having asthma.Average annual per-person asthma-related costs ($616) accounted for less than 20 percent of total per-personhealth care costs ($3,645). Less than 40 percent of the patients received a prescription for a rescue medicationand fewer than 10 percent of the patients who received daily inhaled short-acting beta-2 agonists were regularusers of inhaled steroids. Nonadherence to the guidelines was associated with an increased risk of an asthmarelatedhospitalization.Schatz M, Cook EF, Nakahiro R, Petitti D. Inhaled corticosteroids and allergy specialty care reduce emergencyhospital use for asthma. J Allergy Clin Immunol. 2003;111(3):503-508.Conclusion: Asthma care by allergy specialists and increased use of inhaled corticosteroids reduce use ofemergency hospital services.Specific findings: More than 9,600 asthmatic patients 3 to 64 years of age were identified from an electronicdatabase of a large health maintenance organization. Dispensing of seven or more canisters of inhaledcorticosteroids (ICs) annually and care by an allergy specialist were independently associated with reducedemergency hospital care. Patients with allergy specialist care were more likely than those without specialty careto receive seven or more dispensations of ICs.Schatz M, Zeiger RS, Mosen D, Apter AJ, Vollmer WM, et al. Improved asthma outcomes from allergy specialistcare: A population-based cross-sectional analysis. J Allergy Clin Immunol. 2005;116(6):1307-1313.Conclusion: Allergist care is associated with a wide range of improved outcomes in asthmatic patientscompared with care provided by primary care providers.23
Page 1: Asthma Managementand the Allergist:
Page 5 and 6: SummaryAsthma is among the most com
Page 7 and 8: Asthma in America• Affects 22 mil
Page 9 and 10: When To Refer toan AllergistAccordi
Page 11 and 12: control according to NIH Guidelines
Page 13 and 14: Number of Visits3503002502001501004
Page 15 and 16: Emergency Room VisitsInpatient Care
Page 17 and 18: symptoms and when to seek help for
Page 19 and 20: Specialty Care of Asthmain Health P
Page 21 and 22: References1. Centers for Disease Co
Page 23 and 24: 40. Legorreta AP, Christian-Herman
Page 25: Finkelstein JA, Lozano P, Shulruff
Page 29 and 30: Specific findings: The Epidemiology
Page 32: When To Refer to an AllergistPatien

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