Treatment for mild asthma: What matters to providers

Most patients with asthma have mild asthma, but it has received less attention despite risks of exacerbation, lung function decline, and even death. Provider knowledge, practice patterns, and guidelines used to inform treatment decisions in mild asthma are not well described.

To evaluate provider behaviors in mild asthma and to identify differences between specialists and generalists.

An anonymous survey was distributed nationwide. It evaluated the definition and treatment of mild asthma and familiarity with the National Heart, Lung, and Blood Institute (NHLBI) and Global Initiative of Asthma guidelines. Respondents were categorized as asthma specialists (allergy and pulmonology) and generalists (internal medicine, medicine-pediatrics, and family medicine).

A total of 172 providers participated in the survey, including 76 generalists and 96 specialists. Specialists felt that fewer exacerbations per year were consistent with a diagnosis of mild asthma compared with generalists (1.26 vs 1.58, P = .023). Compared with generalists, specialists were more familiar with asthma guidelines and used both NHLBI and Global Initiative of Asthma documents to guide their practice. In contrast, generalists were more likely to only use NHLBI guidelines. Specialists were more likely to use anti-inflammatory reliever or maintenance and rescue therapy, but both groups most frequently prescribed albuterol alone for reliever therapy in mild asthma (specialists, 57%; generalists, 68%). More specialists had patients with mild asthma use an asthma action plan than generalists (63.5% vs 43.4%, P = .030).

Significant heterogeneity exists in the definition and treatment of mild asthma. Knowledge and use of asthma guidelines differ between generalists and specialists, further complicating management of mild asthma.