Addressing current asthma management: What clinicians told us

A Medscape/CHEST Survey

June 12, 2019 | CHEST Physician

Preferred Biomarkers

Familiarity with biomarkers for moderate or severe asthma is universal among pulmonologists. Only 2% of allergists/immunologists are not familiar with biomarkers, compared with nearly three quarters of EM physicians, 45% of pediatricians, 36% of PCPs, 31% of NP/PA/RNs, and 20% of critical care medicine physicians.

Immunoglobulin E (IgE) levels ranked as the most important biomarker for moderate or severe asthma, favored by 47% of pulmonologists and 50% of allergists/immunologists, followed by eosinophils, preferred by 44% of pulmonologists and 38% of allergists/immunologists. Between 26% and 36% of other clinicians rank IgE tops, except for EM physicians (13%). About one third of critical care medicine physicians and one quarter of PCPs and NP/PA/RNs think eosinophils are the most important biomarker, compared with only 14% of pediatricians and 10% of EM physicians.

Fraction of exhaled nitric oxide (FeNO) is least favored by all clinicians surveyed. Just 9% of pulmonologists, 12% of allergists/immunologists, and 5% of EM physicians like this biomarker. Pediatricians ranked FeNO the highest among those surveyed, but only at 14%.

Assessment Tools and Guidelines

One “interesting” finding is the difference between specialties in use of the Asthma Control Test (ACT) and Asthma Control Questionnaire (ACQ), commented Holley. Most pulmonologists (57%) and allergists/immunologists (79%) favor ACTs for adults and children, whereas other clinicians seem to favor the ACQ.

Both the ACT and ACQ have decent literature to support their use, he noted. “I use the ACT, but personally, I don’t think it makes a difference which you use. I do think it’s important to get an objective score for their subjective symptoms to facilitate tracking over time, and to ensure that clinicians are speaking the same language. For example, if someone else sees my patient for some reason, one look at the ACT score will summarize their disease control, as opposed to them having to pull it out of a running narrative history,” said Holley.

ACTs are also favored by 39% of NP/PA/RNs, 34% of pediatricians, 27% of PCPs, 16% of critical care medicine physicians, and just 6% of EM physicians. About one third of EM physicians and PCPs (34% each) favor the ACQ, as do 30% of NP/PA/RNs, 29% of pediatricians, 20% of pulmonologists, 17% of allergists/immunologists, and 8% of EM physicians.