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DIFFERENCES IN PHYSICIAN’S KNOWLEDGE, ATTITUDES AND RESPONSE TO THE BLACK BOX WARNING ON LONG-ACTING BETA-AGONISTS

North Shore University Hospital, Manhassett, NY

PURPOSE:Background: Inhaled corticosteroids (ICS) and long-acting beta-agonists (LABAs) are the recommended treatment for moderate/severe persistent asthma. The Federal Food and Drug Administration issued a Black Box Warning (BBW) for LABAs, based on literature suggesting asthma mortality was increased with LABAs. The purpose of this study was to investigate if the BBW influenced the practice of specialists (pulmonologists and allergists) and primary care physicians (internists and family physicians).

METHODS:One thousand eighty seven physicians responded to a survey questionnaire to determine their awareness and attitude towards the BBW, whether it changed their practice, and whether discussions with patients occurred regarding the BBW.

RESULTS:Respondents included 429 (38.75%) pulmonologists, 395 (35.68%) allergists, 141 (12.74%) internists, and 132 (11.92%) family physicians.Comparing specialists with PCPs, there was approximately a 10% difference in the rate of knowledge concerning the BBW (99% vs. 90%; (p<0.001). There was a wide variance in agreement with the BBW. About a quarter of specialists agreed with the BBW while 52% of family physicians and 40% of internists agreed. Twice as many PCPs agreed with the BBW compared to specialists (45.6% vs. 24.2%; p<0.001). PCPs were more likely to alter their prescribing habits compared to specialists (40% vs. 34%; p<0.005); however, specialists were more likely to discuss the BBW with patients than PCPs (87% vs. 64%; p<0001). Specialists were approximately 12% more likely to use ICS than PCPs (p<0.001). For second choice of medications, pulmonologists were more likely to choose a LABA (60%) while allergists more likely to choose a leukotriene modifier (57%) (p<0.001). PCPs were divided among the choices and approximately 10% chose LABA monotherapy for initial treatment of asthma.

CONCLUSION:Although the majority of physicians was aware of the BBW for LABAs, there was a difference in how specialists and PCPs perceived it and altered their prescribing habits.

CLINICAL IMPLICATIONS:The BBW for LABAs is perceived somewhat differently by asthma specialists and generalists. Education must be available so that all providers make informed treatment decisions.

DISCLOSURE:Jill Karpel, None.