Do Asthma Sufferers Need Specialists?

Survey: Asthma Patients Happier, Feel Better With Allergists vs. Primary Care Docs

Medically Reviewed by Louise Chang, MD on November 17, 2005
From the WebMD Archives

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."

When patients are more difficult to treat -- and their asthma persists despite common treatments -- Schwartz says it may be time for a primary care doctor to make a referral.

"It is imperative that the primary care physician take the patient's symptoms seriously," he says. "Then the real issue is closely following them. That may be where many primary care doctors fall down. If you don't follow asthma patients closely, making sure they get better, you aren't going to treat as aggressively as you should. This is why some primary care doctors are afraid to use inhaled steroids. Many times, allergists tend to be more aggressive."

But Berger is quick to point out that primary care doctors play an essential role in asthma treatment.

"Every specialist is very willing to work with a patient's primary care doctor in evaluating the patient and having the patient go back to the primary care doctor for regular care," he says. "But because asthma and allergy can have such a huge effect on quality of life, treatment often requires specialty training and a lot of time with the patient."

What About Kids With Asthma?

Schatz's study did not look at children with asthma. But he notes that childhood asthma is even more likely than adult asthma to have an allergy link.

"Children with asthma tend to be more allergic, and they tend to have more features such as eczema and allergic rhinitis," Schatz says. "So for the allergy part of things, getting it earlier and preventing extra problems later, seeing an allergist applies even more."

What an allergist can do better than a pediatrician is figure out the allergic reaction that triggers asthma attacks, says pediatric allergist Lisa Kobrynski, MD, MPH, assistant professor of pediatrics at Emory University in Atlanta.

"Three-fourths of asthmatic kids over the age of 2 years have allergic triggers, usually dust mites or pets or pollen," Kobrynski tells WebMD. "When you're trying to get a handle on asthma, if you can't control the trigger, you will have a harder time getting the asthma under control. So we think anyone with an allergic trigger for asthma should see an allergist to get tested and counseled for environmental control."

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SOURCES: Schatz, M. Journal of Allergy and Clinical Immunology, December 2005; vol 116: pp 1307-1313; online edition published Nov. 11, 2005. Michael Schatz, MD, chief, department of allergy, Kaiser Permanente, San Diego. Robert Schwartz, MD, professor and chairman, department of family medicine and community health, University of Miami Miller School of Medicine. William E. Berger, MD, MBA, professor of medicine, University of California, Irvine. Lisa Kobrynski, MD, MPH, assistant professor of pediatrics, Emory University, Atlanta.

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