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Experts say biologic drugs can help reduce symptoms for some people with asthma. Elena Medoks/Getty Images
  • A recent survey has shown a lack of familiarity among some primary care physicians regarding asthma biologic drugs.
  • Researchers say physicians often defer referrals to asthma specialists until patients experienced multiple exacerbations within a year, indicating potential delays in accessing appropriate treatment.
  • They say these findings underscore a need for improved communication between primary care physicians and specialists to ensure timely and appropriate utilization of biologic treatments.
  • Experts do urge caution to avoid an increase in the inappropriate use of biologic agents for asthma.

Biological therapies for asthma were introduced around two decades ago.

Since their release, an increasing number of people with asthma have found them to be effective in managing their symptoms.

However, a survey presented at the 2023 American College of Allergy, Asthma and Immunology annual scientific meeting revealed that 42% of primary care physicians had limited experience with biological therapies for asthma.

According to the results of the survey, some physicians were unaware of the criteria for initiating such treatments, including the necessity for laboratory assessments, and often delayed referrals to asthma specialists until patients had experienced multiple exacerbations within a year.

The researchers who conducted this survey, which hasn’t been published yet in a peer-reviewed journal, said their goal was to investigate the extent of primary care physicians’ familiarity with asthma biologics.

As part of the survey, the researchers examined the timing of primary care physicians’ referrals of asthma patients with uncontrolled symptoms to asthma specialists and assessed their awareness of the eligibility criteria for initiating biologic treatment.

The questionnaire was distributed electronically to the doctors, including attending and resident physicians from internal medicine, family medicine, and pediatrics departments.

Among the 85 physicians who participated in the survey, 77% indicated they referred patients to specialists after experiencing two or more exacerbations annually.

In addition, 42% of respondents were not acquainted with biologic treatments.

Researchers also noted that 82% of the physicians did not request laboratory tests and 90% did not utilize absolute eosinophil count — a diagnostic test measuring levels of a specific type of white blood cell involved in allergic conditions.

The researchers emphasized that the survey findings underscore the necessity for enhanced communication between primary care physicians and specialists in asthma care, particularly concerning the use of biologic treatments.

Biologics have emerged as crucial assets in managing asthma and various other allergic conditions such as atopic dermatitis (eczema), chronic rhinosinusitis with nasal polyps, and eosinophilic esophagitis.

They noted that administering these drugs promptly to eligible people can help prevent significant adverse outcomes.

The researchers also discovered that the frequency of referrals by primary care physicians to specialists did not affect their familiarity with biologics or their understanding of eligibility criteria.

However, primary care physicians who had more frequent encounters with people with asthma as well as those who referred patients to specialists were more inclined to conduct laboratory tests for asthma management.

Dr. Jared Ross, a professor and medical director at the Henry Ford College Paramedic Program and the medical director for Trauma Services at Bothwell Regional Health Center in Missouri who was not involved in the survey, told Medical News Today that there is a growing body of literature that biologic agents are being used excessively and inappropriately in people with asthma.

Biologic agents are very expensive and carry non-insignificant risks of severe allergic reactions (anaphylaxis) and blood clots in the legs or lungs, both of which can be fatal. While biologics are likely a better alternative to long-term oral steroids, both options are considered last resort for patients who do not respond to maximal therapy.

Dr. Jared Ross

Dr. Kartik Shenoy a pulmonologist at Temple University Hospital in Philadelphia who specializes in asthma, agreed, saying, “the survey echoes the need for further education about asthma in the healthcare community.”

“Primary care is often the front line of asthma care and having [primary care physicians] know what tools are available to treat severe asthma, along with the co-morbid conditions that accompany it, is vital to taking care of patients,” Shenoy, who was not involved in the survey, told Medical News Today.

Ross noted that “maximal therapy includes a combination maintenance inhaler (steroid & long-acting beta agonist) as well as an inhaled long-acting muscarinic antagonist, oral antileukotriene agent (such as montelukast), and a rescue inhaler (short-acting beta agonist) as needed.”

Shenoy noted how this survey is “a good reminder that patients should also take ownership of their health.”

“Having an open and honest conversation about your asthma symptoms with your primary may help them fully understand how poorly you are feeling,” he said.

“This can be accomplished ahead of your primary visit by filling out patient questionnaires such as the airQ (airQscore.com) or ACT (asthmacontroltest.com) score and discussing the results with your provider,” Shenoy added.

Ross agreed but also highlighted that “primary care physicians should be focused on helping patients improve medication compliance and escalating from Global Initiative for Asthma (GINA) step 1 up to step 4 as needed.”

“Once a patient has failed GINA step 3 or 4, they should be referred to an asthma specialist (allergist or pulmonologist) for further workup and management,” he said.

Experts say it is important to note that surveys may lack representativeness and may not be applicable to all healthcare providers.

Ross concluded by saying that “I am concerned that this survey may increase the inappropriate use of biologic agents for asthma.”