Abstract

Objectives: To assess current detection and intervention strategies for pediatric asthma, frontline healthcare providers in an urban environment, and to identify provider-level barriers to guideline-concordant care. 
Methods: Between March and May 2025, a cross-sectional multicenter survey was administered to a stratified random sample of 450 healthcare providers (pediatricians, general practitioners, nurse practitioners, and registered nurses) working in primary care clinics and pediatric hospitals. A 48-item questionnaire (practice subscale Cronbach’s α = 0.84) measured screening practices, diagnostic test availability (spirometry, FeNO), use of personalized asthma action plans (PAAPs), early-intervention strategies, and perceived barriers. Data collection were electronic, analyses were performed using SPSS v.29.
Results: Of 450 invited, 338 providers completed the survey (response rate 75.1%). Of those surveyed, 64.8% report use of symptom-based screening for asthma in children (n = 219), 42.6% report office spirometry availability (n = 144), and 9.8% report point-of-care FeNO availability (n = 33). Among the participants, 51.2% reported giving personalized asthma action plans on a routine basis. When adjusted for years in practice and setting, multivariable logistic regression showed that having on-site spirometry (adjusted OR 2.09, 95% CI 1.38-3.17, p < .001) and having taken training for asthma in the last 3 years (adjusted OR 1.84, 95% CI 1.22-2.78, p = .004) were significant predictors of guideline-concordant practice (as defined below). Main perceived barriers included lack of equipment/time (68%), inadequate training (54%), and not enough reimbursement (41%).
Conclusions: Across the various sites in this urban sample, objective testing (spirometry, FeNO) and systematic use of PAAPs were inconsistently outfitted. On-site spirometry and recent provider training were linked to a higher probability of early detection and intervention in accordance with guidelines. Interventions to improve access to objective testing and educate primary care providers may lead to better early detection and less preventable exacerbations.