CHEST 2026 asthma implementation science abstract

Healthcare system level data identifies critical gaps in severe asthma care

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Purpose
Global asthma guidelines recommend that patients with severe asthma are referred to an expert in asthma management and considered for treatment with a biologic. The aim of this study was to evaluate treatment patterns and specialist care among patients with severe asthma using high quality real-world data from a large healthcare system.

Methods
This was a retrospective cohort study using the INSIGHTS Pragmatic Registry, a longitudinal registry of patients with severe asthma that leverages data collected from routine clinical care. It includes linked claims, structured and unstructured electronic health record (EHR), and death registry data with optimized and reported data reliability. Eligibility criteria included diagnosis of severe asthma, age 12 or older, no biologic receipt in the 12 months prior to severe asthma diagnosis, and documentation of care between January 1, 2020 and December 31, 2024. Severe asthma was ascertained through physician documentation (diagnosis code or occurrence in unstructured EHR) or using a medication-based algorithm. The index date was defined as the earliest date a patient met eligibility criteria within the study period. Demographic characteristics, medications, and specialist care at baseline were described. Treatment and specialist care patterns were evaluated by calculating the 12-month cumulative incidence of 1) receiving a biologic and 2) receiving allergist or pulmonologist care, overall and by calendar year of severe asthma diagnosis. Multivariable logistic regression was used to evaluate the association between receipt of specialist care and treatment with a biologic.

Results
There were n=1,127 patients included in the study. Median age at index was 50 (IQR, 36 to 60). Patients were predominantly white (75%), female (75%), non-Hispanic (95% not including unknown ethnicity). Private health insurance was the most common (44%) type of coverage at baseline. Most patients had a prescription for inhaled corticosteroids in the 12 months prior to index (94%) and more than half (56%) had a prescription for oral corticosteroids. Biologic treatment following diagnosis of severe asthma was uncommon (6.8%). The 12-month cumulative incidence of biologic treatment following diagnosis of severe asthma increased from 3.8% to 5.8% between 2020 and 2023. The 12-month cumulative incidence of receiving specialist care was approximately 20% across all years. Biologic treatment was more prevalent among patients who received specialist care (15.6%) than patients who did not receive specialist care (4.5%). Logistic regression results were consistent with this finding; receipt of specialist care was associated with an increased likelihood of treatment with a biologic (odds ratio [OR] 1.77, 95% confidence interval [CI] 1.09 to 2.87, p-value 0.021). Patients with Medicare were less likely to receive a biologic (OR 0.40, 95% CI 0.16 to 0.91, p-value 0.038).

Conclusions
Contrary to global guidelines, patients with severe asthma are rarely referred to specialists. Furthermore, while patients are more likely to receive biologic treatment if they are receiving care from a specialist, biologic use remains low even among patients treated by specialist providers.

Clinical implications
This study using high-quality data from a large academic healthcare system identifies critical opportunities to improve care delivery to drive healthcare outcomes.