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Spirometry in Bronchial AsthmaSpirometry in Asthma: Role of TB: Role of TB FREE TO VIEW

Naveen Dutt
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From the Department of Respiratory Medicine, Bhagat Phool Singh Government Medical College.

Correspondence to: Naveen Dutt, MD, Department of Respiratory Medicine, Bhagat Phool Singh Government Medical College, Khanpur, Haryana 131305, India; e-mail: drnaveendutt@yahoo.co.in


Financial/nonfinancial disclosures: The author has reported to CHEST that no potential conflicts of interest exist with any companies/organizations whose products or services may be discussed in this article.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2012;142(4):1072. doi:10.1378/chest.12-1255
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To the Editor:

In an issue of CHEST (May 2012), Gershon et al1 raised an important but often forgotten issue of spirometry for the diagnosis of bronchial asthma. Spirometry undoubtedly is the cornerstone for the diagnosis of bronchial asthma, and it is equally true that for whatever reason it remains underused throughout most of the world. There are several reasons for its underuse, which vary with country and area. In developing countries, along with the expected reasons of scarcity of physicians and technicians, nonavailability of spirometry, and other basic issues, there is one more important, but expected, factor: TB.

In developing countries like India and China, a sizeable population has past or present TB. Prevalence of TB infection is as high as 40% in India.2 Moreover TB may mimic bronchial asthma (eg, endobronchial TB may present with dyspnea and wheezing). In areas with high TB prevalence, physicians usually rule out TB in almost all patients presenting in chest clinics with any chest symptom. If spirometry is done in a case of pulmonary TB, it may infect the apparatus and spread the infection.3 Thus, as a silent policy it is considered unsafe to use spirometry without having a chest radiograph of the patient. If the radiograph findings suggest TB, which is not a rare scenario, sputum microscopy is required to rule out present active TB. This prolonged diagnostic protocol means more hospital visits and a delay in diagnosis and treatment. This delay is unacceptable when the patient is visibly in discomfort, which often is the case because patients present late in the course of disease. Understandably, physicians feel safer and more comfortable with starting treatment without spirometry than in taking a risk of the spread of infection. There is a need to develop a consensus statement regarding the use of spirometry in countries with a high TB prevalence.

Gershon AS, Victor JC, Guan J, Aaron SD, To T. Pulmonary function testing in the diagnosis of asthma: a population study. Chest. 2012;141(5):1190-1196. [PubMed] [CrossRef]
 
Narain R, Geser A, Jambunathan MV, Subramanian M. Some aspects of a tuberculosis prevalence survey in a south Indian district. Bull World Health Organ. 1963;29:641-664.
 
Hazaleus RE, Cole J, Berdischewsky M. Tuberculin skin test conversion from exposure to contaminated pulmonary function testing apparatus. Respir Care. 1981;26(1):53-55.
 

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References

Gershon AS, Victor JC, Guan J, Aaron SD, To T. Pulmonary function testing in the diagnosis of asthma: a population study. Chest. 2012;141(5):1190-1196. [PubMed] [CrossRef]
 
Narain R, Geser A, Jambunathan MV, Subramanian M. Some aspects of a tuberculosis prevalence survey in a south Indian district. Bull World Health Organ. 1963;29:641-664.
 
Hazaleus RE, Cole J, Berdischewsky M. Tuberculin skin test conversion from exposure to contaminated pulmonary function testing apparatus. Respir Care. 1981;26(1):53-55.
 
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