Rachel White, from the University of Rochester Medical Center

Rachel White, MS

 Caregiver Perceptions Highlight Gaps in Pediatric Asthma Specialist Access

Fewer than 2 in 10 children with poorly controlled asthma in marginalized communities had seen a pulmonologist or allergist in the prior year, a new study showed.

This sub-analysis of the TEAM-UP trial illustrates a disconnect between guideline recommendations and real-world care. Although caregiver support for specialty care was high—81% reported believing that a specialist visit would benefit their child—structural, communication, and referral barriers limited actual access.

“I think the overall perception…is positive,” investigator Emily Aman, MPH, from the University of Rochester Medical Center, told HCPLive. “Maybe [there’s] some medical mistrust, [but] I think overall, they're receptive to this specialized care. We just need to figure out how to remove some of the barriers that exist.”

Among 325 children aged 4 to 12 years from Rochester, New York, 37% had ever seen an asthma specialist, and 16% had seen one in the past year. The cohort was predominantly publicly insured (80%), with 58% identifying as Black and 35% as Hispanic. Black children accounted for only 39% of those who had ever received specialty care, highlighting racial disparities.

Children from households with annual incomes ≥$35,000, caregivers with higher education levels, and married or partnered caregivers were more likely to access specialty care. Comorbidities and environmental exposures, including allergic rhinitis (38%) and household smoke exposure (42%), were prevalent across the cohort, indicating that all children met referral thresholds regardless of risk factors.

The study ultimately demonstrated that caregiver receptiveness is high and primary care provider referrals are critical, despite only 23% of caregivers reporting receiving a referral.

“This all points to the need for a multi-faceted approach to reducing barriers using things like telemedicine, which you know is being used for many health conditions for children, including asthma,” said investigator Rachel White, also from the University of Rochester Medical Center.

White continued by talking about how telemedicine can reduce transportation barriers. Some explained that some regions have mobile clinics to combat these transportation barriers.

“We're actually working on a project right now that's partnering with school nurses to make specialist care and asthma care in general more accessible to school-age kids,” White said. “Building those partnerships with school health staff and providers is also very important.”

Aman E, White RN, Stern J, et al. Pediatric asthma specialist care utilization among marginalized children with poorly controlled asthma. 

. 2026;63(2):198-205. doi:10.1080/02770903.2025.2581016

Aman E and White R. Most Marginalized Children with Uncontrolled Asthma Miss Specialist Care. HCPLive. Published on February 7, 2026. Accessed on February 10, 2026. https://www.hcplive.com/view/most-marginalized-children-uncontrolled-asthma-miss-specialist-care

Videos

In an interview with HCPLive, Emily Aman, MPH, and Rachel White, share that most marginalized children with uncontrolled asthma miss specialist visits despite caregiver support due to existing barriers.

Caregiver Perceptions Highlight Gaps in Pediatric Asthma Specialist Access

https://youtu.be/o6w6rP1iKVw Most Marginalized Children with Uncontrolled Asthma Miss Specialist Care

Children in marginalized communities with poorly controlled 

 rarely receive guideline-recommended specialist care, with fewer than 2 in 10 seeing a pulmonologist or allergist in the prior year despite meeting clear criteria for referral.

“I think there could be room for more education on the role of specialists and their expertise in managing this condition,” said investigator Emily Aman, MPH, from the University of Rochester Medical Center, in an interview with 

. “A lot of it also goes back to communication and health literacy as well.”

Aman and colleagues conducted a sub-analysis of the Telemedicine Enhanced Asthma Management–Uniting Providers (TEAM-UP) trial, which had enrolled children from Rochester, New York, with uncontrolled asthma. Among 325 children aged 4 to 12 years, only 37% had ever seen an asthma specialist, and just 16% had done so within the previous 12 months.

The cohort was predominantly publicly insured (80%), with 58% identifying as Black and 35% as Hispanic. Although Black children made up more than half of the overall sample, they accounted for only 39% of those who had ever received specialist care, highlighting a clear racial disparity in access.

Children who received pulmonology or allergy care were more likely to come from households with higher income (≥ $35,000 annually), greater caregiver education levels, and married or partnered caregivers. These children were also younger and more frequently identified as Hispanic. Insurance status alone did not appear to overcome these structural factors.

Caregiver awareness of a referral from a primary care clinician substantially increased the likelihood that a child had seen a specialist in the past year. However, only 23% of caregivers reported that their child had been referred at all. The findings also point to gaps in communication, health literacy, and follow-through between primary care, families, and specialty services.

Environmental and comorbid factors further contextualized unmet need. Among children who had not seen a specialist, 38% had caregiver-reported allergic rhinitis and 42% had smoke exposure in the home, both well-established contributors to poor asthma control. These characteristics were also common among children who did receive specialty care, reinforcing that all children in the cohort met guideline thresholds for referral regardless of comorbidity burden.

The data highlight a mismatch between evidence-based recommendations and real-world practice, suggesting that improving referral processes, caregiver education, and system-level support may be as essential as expanding specialist capacity to reduce inequities in pediatric asthma outcomes.

“What's important is that these are not only national but also global guidelines that they all of these children should have equal access to seeing a specialist,” investigator Rachel White, from the University of Rochester Medical Center, told 

. “There shouldn't be any priority based on whether or not you also have allergic rhinitis or how much smoke…you have in the home. All of these children… should be able to see an asthma specialist.”

In an interview, investigators Emily Aman, MPH, and Rachel White highlight why marginalized children with uncontrolled asthma rarely see specialists.

Rachel White, MS

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