Asthma in Primary Care: Spirometry Underused in Diagnosis

This article is part of Pulmonology Advisor‘s coverage of the American Academy of Allergy, Asthma & Immunology, taking place in Orlando, Florida. Our staff will report on medical research related to asthma and other respiratory conditions, conducted by experts in the field. Check back regularly for more news from AAAAI/WAO 2018.

ORLANDO — Spirometry may be underused in primary care for the diagnosis and monitoring of asthma, according to research presented at the 2018 Joint Congress of the American Academy of Allergy, Asthma & Immunology/World Allergy Organization (AAAAI/WAO), held March 2-5, in Orlando, Florida.¹

Researchers conducted a cross-sectional study with a retrospective chart review of 400 adult patients (mean age, 52.1 years), split evenly between academic and private facilities. More patients who attended academic facilities underwent spirometry compared with those who attended private clinics (56.7% vs 43.3%; P =.005). In addition, patients who were older, obese, Hispanic, and of lower socioeconomic status were significantly more likely to undergo spirometry.

In the assessment of asthma, spirometry was most often ordered as an incident study as opposed to monitoring or subsequent study (67.3%). Only 9.1% of patients without spirometry were ever referred to specialists, 59.1% were not referred, and 31.7% had unknown referral history. Approximately 41.0% of patients had monitoring and subsequent spirometry performed.

The researchers determined that 36.8% of patients had asthma while 52.7% of patients had unclear diagnoses based on a full chart review. A few patients (10.4%) had other conditions, such as gastroesophageal reflux disease, obesity, rhinitis, or cardiac conditions. Nearly all patients (99.0%) were prescribed asthma medications, including 100% of patients who underwent spirometry and 97.8% of patients who did not.

Jasdeep Badwal, MD, one of the study investigators, noted that referral rates from primary care physicians to specialists (both to pulmonologists and to ear, nose, and throat specialists) were extremely low. Asthma is a dynamic disease, Dr Badwal explained, and periodic reassessment of a patient’s condition and medications is necessary.

As a result, patients may be misdiagnosed and taking inappropriate treatments, the investigators found. Previous studies have reported “a poor correlation between subjective symptoms and the degree of obstruction seen on spirometry, and in one study, up to 27% of physicians using symptoms alone for diagnosis underestimated asthma severity.”²

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References

1. Badwal J, Singh D, Alkhatib F, Mujahid R, Lagu T. Spirometry utilization in primary care — adherence to national asthma guidelines. Presented at: 2018 American Academy of Allergy, Asthma & Immunology/World Allergy Organization Joint Congress; March 2-5, 2018; Orlando, FL. Poster 339.
2. Celli BR. The importance of spirometry in COPD and asthma: effect on approach to management. Chest. 2000;117(2 Suppl):15S-9S.