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Do Asthma Sufferers Need Specialists?
Nov. 17, 2005 -- Asthma patients who see allergists say they're better off than those who see primary care doctors.
The finding comes from a survey of 3,568 adult asthma patients enrolled in the Kaiser Permanente HMO. About half the patients got asthma care from a primary care doctor. About a quarter of the patients got their asthma care from an allergist.
Those who saw allergists reported:
- Better quality of life
- Better control of their asthma
- More satisfaction with their asthma care
- More knowledge about self-care for their asthma
- Fewer hospitalizations for asthma
Michael Schatz, MD, allergy chief at Kaiser Permanente in San Diego and a past president of the American Academy of Allergy, Asthma, and Immunology, led the study. His research team reports the findings in the December issue of the Journal of Allergy and Clinical Immunology.
When to See an Asthma Specialist
Schatz says it's not true that every asthma patient needs to see an allergy specialist. Nor does every asthma sufferer who sees an allergist need to remain in specialty care. But asthma patients should know when it's time to seek expert help.
"If the goals of treatment aren't being met, see a specialist," Schatz tells WebMD. "The goal is infrequent symptoms during the day, minimal or no nighttime symptoms, and no limit on activities including exercise. You want normal breathing -- and no acute attacks that end up sending you to the hospital, or side effects from asthma medications. If all that is being met, a person with asthma may not need anything further."
The problem for primary care doctors isn't lack of goodwill or medical know-how. It's lack of time and, often, lack of the proper equipment, says William E. Berger, MD, MBA, professor of medicine at the University of California, Irvine. Berger is past president of the American College of Allergy and Immunology and author of Allergies and Asthma for Dummies.
Berger notes that difficult-to-assess allergy problems often underlie asthma.
"In many cases primary care doctors do not have the time or expertise to do an allergy evaluation -- it can take up to a full hour," Berger tells WebMD. "And lung-function testing, which is needed to classify asthma patients, is not always available to primary care doctors. The idea of getting treated for asthma without getting lung-function testing has never made much sense to me."
What Primary Care Docs Say
Primary care doctors can prescribe the same medications as allergy specialists. But they don't see as many asthma patients as allergists, says Robert Schwartz, MD, chairman of the department of family medicine and community health at the University of Miami Miller School of Medicine.
"Part of the problem is that if primary care doctors don't see all that many patients with asthma, then they may shy away from more aggressive treatments," Schwartz says. "But anybody who does this on a regular basis uses the same evidence-based treatments as specialists, and their patients usually do quite well."
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