PURPOSE: Intense focus on asthma as a prevalent and treatable condition has resulted in a heightened awareness about this disease among physicians but has also led to mis-diagnosis of asthma in the community. Asthma is associated with large healthcare expenditures. Medications for asthma itself account for 38% of the total cost of asthma. We conducted this study to explore clinical characteristics of patients with asthma like symptoms but negative methacholine challenge test (MCT) and also the subsequent treatment regimen after a negative MCT.
METHODS: We did a retrospective chart review from 71 adults who reported asthma like symptoms and underwent MCT. We compared the clinical characteristics of patients with negative and positive MCT. We also analyzed the treatment regimen before and after the MCT results.
RESULTS: Of the 71 subjects tested, 51(71%) patients had a negative MCT. Patients with a negative MCT were more likely to have an absence of chest tightness (P 0.03) and wheezing (P 0.003) as compared to patients with a positive test. There was no difference between the FEV1 values between the two groups although patients with negative MCT had higher values of FEF 25-75 as compared to patients with positive test. Out of the patients with a negative MCT 80% (C.I 69%-91%) continued to be on asthma medications.
CONCLUSIONS: Patients with negative MCT were more likely to have absence of wheezing and chest tightness as compared to patients with a positive test. A significant proportion of patients with a negative MCT were continued on asthma medications by their primary care physicians.
CLINICAL IMPLICATIONS: Thorough history should be obtained from patients presenting for asthma evaluation as certain symptoms or a lack thereof may indicate the likelihood of presence or absence of asthma. Continuing asthma medications on patients without asthma, is a not only a misuse of resources but also a burden on the patients with the cost. More effort is required to educate primary care physicians about MCT and its implications, to avoid unnecessary use of medications.
DISCLOSURE: The following authors have nothing to disclose: Monisha Das, Rajiv Chhabra, Gary Salzman
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