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.”

References

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