Pulmonary specialist health coach consultation model: a randomized controlled trial

Rationale: Socioeconomically disadvantaged patients with asthma and/or chronic obstructive pulmonary disease (COPD) face barriers to evidence-based care that are difficult to overcome in health care settings with limited resources. Objectives: Evaluate the efficacy of a pulmonary-specialist-health coach consultation model (intervention) for patients with asthma and/or COPD, relative to usual care (control). Methods: Randomized-controlled trial of 16 weeks of intervention versus control for adult English- or Spanish-speaking, low-income patients. Intervention: a lay health coach gathered information from the patient and medical record for remote review by a pulmonary specialist, who provided general recommendations to the primary care clinician. The coach supported implementation of recommendations. Measurements: Primary outcomes were receipt of guideline-based care and medications. Secondary outcomes were receipt of chronic lung disease education, breathing-related quality of life and symptoms, patient-rated quality of care, and adherence to inhaler therapy. Longitudinal models for count data were used to estimate Intervention: Control relative rates. Parallel models for continuous data estimated relative means. Main results: A total of 165 intervention participants received 1.61-fold more guideline-based care than 163 control participants (relative ratio; 95% CI: 1.37-1.90). They were not more likely to receive guideline-based medications in planned analysis using a pooled baseline rate, although post-hoc analysis using arm-specific baseline rates found significant improvement. Intervention patients received more chronic lung disease education and reported greater improvements in breathing-related quality of life, symptoms, and patient-reported quality of care. Conclusions: This intervention offers a scalable approach to improve uptake of clinical guidelines in resource-limited primary care practices managing most asthma and COPD care. Descriptor number: 2.9 Racial, ethnic, or social disparities in lung disease and treatment. Clinical trial registration: NCT03695276 © The Author(s) 2026. Published by Oxford University Press on behalf of the American Thoracic Society. This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact reprints@oup.com for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact journals.permissions@oup.com.