Abstract Rationale Pulmonary function testing (PFT) is central to asthma diagnosis, phenotyping, and monitoring, yet real-world adherence to guideline-recommended testing remains low.We wanted to assess PFT utilization and pulmonology follow-up rates among adults with severe uncontrolled asthma and evaluate their associations with disease management and demographics as understanding current utilization patterns of PFT and pulmonology engagement in severe asthma may reveal key opportunities to improve outcomes. Methods We conducted a retrospective cohort analysis of 740 adults with severe uncontrolled asthma treated across the Allegheny Health Network (09/2023-09/2024). Demographics, comorbidities, inhaler use, biologic therapy, and specialty visits were extracted from electronic health records. Associations between categorical variables were assessed using chi-square or Fisher’s exact tests, and nonparametric tests compared prednisone exposure (α = 0.05). Subgroup analysis was performed for biologic users (n = 81). Results The mean age was 55.6 ± 17.6 years; 72.3% were female and 76.6% White. Overall, 54.6% underwent PFT and 56.5% had pulmonology follow-up. PFT completion was significantly associated with inhaler regimen (p 0.0001): patients on ICS/LABA or triple therapy had higher testing rates (62.9%) than those on SABA-only (37.0%) or no inhaler (31.5%). Similarly, pulmonology follow-up was more frequent in advanced-inhaler users (63.7%) than SABA-only (43.0%) or none (31.5%; p 0.0001). In contrast, PFT and pulmonology follow-up showed no significant association with gender (p = 0.95) or race (p = 0.09), suggesting equitable access across demographic groups. Among biologic-treated patients (n = 81), 87.5% completed PFTs and 85.2% attended pulmonology visits, demonstrating strong adherence to guideline-based care. The median cumulative prednisone dose was 300 mg (IQR 49-668 mg). Although OCS exposure remained substantial, the study did not directly assess its relationship with testing or specialty engagement. Discussion Despite clear guideline emphasis, nearly half of adults with severe uncontrolled asthma lacked recent PFT evaluation. Pulmonology engagement markedly improved adherence to diagnostic testing and inhaler optimization. These findings highlight system-level, rather than patient-level, barriers to optimal care. Proposed strategies include automated PFT reminders in EHRs, embedding PFT scheduling in pulmonology orders, standardizing post-exacerbation specialty referrals, and integrating inhaler education and FeNO monitoring into multidisciplinary asthma pathways.1 In summary, Pulmonology engagement significantly improves PFT utilization and adherence to evidence-based asthma management. Embedding structured follow-up and automated testing workflows may close critical care gaps in severe asthma. References 1. Skolnik et al., “Best Practice Advice for Asthma Exacerbation Prevention and Management in Primary Care.” This abstract is funded by: None
Gul et al. (Fri,) studied this question.