Abstract Rationale Asthma is the most common chronic respiratory disease in children and remains a leading cause of emergency department visits, hospitalizations, and school absenteeism. Recent guidelines from the National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) now strongly recommend Maintenance and Reliever Therapy (MART) for children aged ≥5-6 years with moderate-to-severe asthma, citing reduced exacerbation risk and simplified management. However, real-world adoption of MART in pediatric practice remains poorly characterized. This study evaluated MART prescribing patterns among pediatric patients across a large healthcare system, including its documentation in asthma action plans (AAPs), and co-prescription with short-acting beta agonists (SABAs). Methods We conducted a retrospective cohort study of pediatric asthma visits between December 2020 and June 2025 among patients aged 5-17 years. Encounters were randomly selected from pulmonology, allergy and primary care clinics across a large healthcare system. Patient and clinician characteristics were abstracted from the electronic medical record (EMR). MART eligibility was defined as treatment at GINA Step ≥3 or ≥ 2 exacerbations in the prior year. For each visit, we reviewed the prescription instructions, assessment and plan, and AAP to determine how often MART was documented in each component of the EMR. We also assessed the frequency of short-acting beta-agonist (SABA) co-prescribing and compared MART prescribing rates across patient- and provider-level factors. Results We reviewed 490 randomly selected pediatric asthma visits, with 97.3% inter-reviewer agreement between two independent reviewers. The cohort included 278 males (56.7%) with a mean age of 9.6 years (standard deviation SD 3.7). Among all visits, 331 (67.6%) were eligible for MART, but only 107 (32.3%) of those eligible were prescribed MART in at least one EMR component. Among patients prescribed MART, 63 (58.8%) had MART documented across all EMR components, while only 19 (5.7%) had their SABA removed from their medication list. MART prescribing rates were highest among allergists (43.1%), followed by pulmonologists (27.6%), and primary care providers at 5% (Figure). Conclusion MART prescribing among academic pediatric clinicians remains limited despite clear guideline recommendations and supporting evidence. We observed inconsistent documentation across EMR components and infrequent removal of SABA prescriptions when MART was prescribed. Focused efforts are needed to increase MART adoption among pediatric subspecialists and primary care providers. This abstract is funded by: None
Peled et al. (Fri,) studied this question.