The objective of this study is to review electronic medical records with a new diagnosis of asthma to determine if objective measures of lung function (spirometry, peak flow, or bronchodilator response) were used in establishing the diagnosis.
The DoD electronic medical record for our institution was searched for the new diagnosis of asthma during 2007–2008. Clinical symptoms, spirometry, peak flow data, type of clinic and treatment were recorded. Spirometry data was specifically analyzed to determine if findings were consistent with obstructive lung disease.
Preliminary review identified a new ICD-9 code for asthma in 284 patient records. Greater than 80% of patients were evaluated solely by a primary care service. Based on an in-depth review, it was determined that only 55% of patients underwent spirometry as part of the diagnostic process. Evidence of airways obstruction based on FEV1/FVC ratio or decrease in FEF 25–75 was found in 27% of all spirometry exams. Post-bronchodilator readings were performed in less than 5% of patients.
Primary care clinics underutilize spirometry in the initial evaluation of patients with suspected asthma. Even when screening spirometry is utilized, it is interpreted incorrectly as obstructive lung disease.
The 2007 NHLBI asthma guidelines emphasize the need for objective measures of lung function to establish the diagnosis of asthma. With the event of portable spirometry and the ability to utilize this technology in most providers’ offices, there should be few cases in which spirometry has not been performed. Previous studies have shown that in upward of 30% of patients, the diagnosis of asthma is incorrect. Accurate diagnosis of asthma based on objective measurements of lung function can lead to better treatment and management of asthma.
Christy Sine, No Financial Disclosure Information; No Product/Research Disclosure Information