Environmental management of asthma in clinical practice: Results from the 2012 National Ambulatory Medical Care Survey

Paivi M Salo; Lara J Akinbami; Michelle M Cloutier; Jesse C Wilkerson; Kurtis S Elward; Jacek M Mazurek; Gregory B Diette; Tracey A Mitchell; Sonja Williams; Darryl C Zeldin

doi:10.1016/j.jacig.2023.100192

Environmental management of asthma in clinical practice: Results from the 2012 National Ambulatory Medical Care Survey

J Allergy Clin Immunol Glob. 2023 Nov 22;3(1):100192. doi: 10.1016/j.jacig.2023.100192. eCollection 2024 Feb.

Authors

Affiliations

¹ Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, Research Triangle Park, NC.
² National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Md.
³ United States Public Health Service, Rockville, Md.
⁴ Department of Pediatrics, University of Connecticut, Farmington, Conn.
⁵ Social & Scientific Systems, a DLH Holdings company, Durham, NC.
⁶ Department of Family Medicine and Population Health, The Virginia Commonwealth University, Richmond, Va.
⁷ National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.
⁸ Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Md.
⁹ Environmental Protection Agency, Washington, DC.

Abstract

Background: The National Asthma Education and Prevention Program guidelines emphasize environmental control as an integral part of asthma management; however, limited national-level data exist on how clinicians implement environmental control recommendations.

Objective: We analyzed data on clinicians' self-reported use of recommended environmental control practices in a nationally representative sample (n = 1645) of primary care physicians, asthma specialists, and advanced practice providers from the National Asthma Survey of Physicians, a supplemental questionnaire to the 2012 National Ambulatory Medical Care Survey.

Methods: We examined clinician and practice characteristics as well as clinicians' decisions and strategies regarding environmental trigger assessment and environmental control across provider groups. Regression modeling was used to identify clinician and practice characteristics associated with implementation of guideline recommendations.

Results: A higher percentage of specialists assessed asthma triggers at home, school, and/or work than primary care or advanced practice providers (almost always: 53.6% vs 29.4% and 23.7%, respectively, P < .001). Almost all clinicians (>93%) recommended avoidance of secondhand tobacco smoke, whereas recommendations regarding cooking appliances (eg, proper ventilation) were infrequent. Although assessment and recommendation practices differed between clinician groups, modeling results showed that clinicians who reported almost always assessing asthma control were 5- to 6-fold more likely to assess environmental asthma triggers. Use of asthma action plans was also strongly associated with implementation of environmental control recommendations.

Conclusions: Environmental assessment and recommendations to patients varied among asthma care providers. High adherence to other key guideline components, such as assessing asthma control, was associated with environmental assessment and recommendation practices on environmental control.

Keywords: Asthma; asthma guidelines; environmental control; guideline implementation; national survey.