Spirometry underused in primary care
BOSTON — Only slightly more than half of all patients presenting to primary care providers with asthma underwent spirometry for diagnosis, according to a presenter at the American College of Allergy, Asthma and Immunology annual meeting.
This finding is despite recommendations from the National Asthma Education and Prevention Program Expert Panel Report that spirometry be used for these patients.
“Clinical history alone is insufficient in the diagnosis of asthma,” Jasdeep Badwal, MBBCh, a second-year fellow in allergy and immunology at the University of Rochester Medical Center in New York, told Healio Family Medicine. “I was surprised to find that many primary care physicians based asthma diagnoses and management on symptoms alone.”
He added that there were “little to no” spirometry data to guide treatment.
Badwal conducted a retrospective review of 394 patients (mean age, 52.1) whose electronic medical record had an ICD-9 code indicating asthma.
He found that 52.8% of these patients underwent spirometry. Of those, 67.3% had spirometry ordered as an incident study as opposed to a monitoring or subsequent study in the assessment of asthma. Of the 186 remaining patients who did not undergo spirometry, 59.1% had not been referred, 31.7% had no data available and only 9.1% had been referred for spirometry. Monitoring/subsequent spirometry was conducted in 40.9% of patients, Badwell wrote.
In addition, a full review of all 394 patients’ health records showed “a small but significant minority” (10.4%) were judged to not have asthma; 36.8% of patients did have asthma; and in 52.7% of patients, the diagnosis was unclear, according to Badwal.
“Yet, nearly all of these patients were prescribed asthma medications,” he said.
Badwal suggested PCPs familiarize themselves with the expert panel guidelines.
“PCPs should regularly order spirometry to help establish the diagnosis of asthma and also to monitor disease progression in those patients with an established diagnosis,” Badwal said. “PCPs should also routinely perform spirometry every 1 to 2 years in controlled asthmatics or sooner for those patients with continued symptoms to aid in evaluating lung function and medication management. These clinicians should also consider alternative diagnoses such as GERD, heart disease and obesity that can present with symptoms similar to asthma,” he added. – by Janel Miller
Badwal J. Poster 226. Presented at: the American College of Allergy, Asthma and Immunology 75th Annual Scientific Meeting; Oct. 26-30, 2017; Boston.
NIH National Heart, Lung and Blood Institute. Summary Report 2007: National Asthma Education and Prevention Program Expert Panel Report 3 Guidelines for the Diagnosis and Management of Asthma. https://www.nhlbi.nih.gov/files/docs/guidelines/asthsumm.pdf. Accessed Oct. 25, 2017.
Disclosure: Badwal reports no relevant financial disclosures.