The National Asthma Education and Prevention Program (NAEPP) and the American Thoracic Society recommend spirometry to help diagnose asthma, but studies have shown it is markedly underused. Indeed, researchers from the University of Texas Medical Branch in Galveston who evaluated trends over 10 years found that since NAEPP published revised comprehensive guidelines in 2007, the number of patients who receive spirometry has declined. The researchers analyzed data from 134,208 patients diagnosed with asthma; only 47.6% had been tested with spirometry within 1 year of diagnosis.
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Current guidelines recommend spirometry at the time of initial assessment, after treatment is initiated and symptoms and peak expiratory flow have stabilized, during periods of progressive or prolonged loss of asthma control, and at least every 1 to 2 years. But according to the American Academy of Allergy, Asthma, and Immunology, the researchers say, clinicians often rely on symptoms alone when diagnosing and managing asthma, regardless of the fact that symptoms may be misleading.
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Decreased spirometry testing means increased use of controller medications, the findings suggest. For patients with asthma for whom spirometry was not used, 78.3% received inhaler therapy. Over 50% of patients with asthma who were not given spirometry were on controller medications.
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The researchers also discussed how spirometry testing is more cost-effective than is overuse of controller medications. Spirometry costs about $42 compared with $200 to $300 a month for unnecessary use of an inhaled corticosteroid. They also discuss how an emergency department visit for an asthma episode can total $3,500, and the cost of caring for patients with asthma in the U.S. is more than $56 billion a year.
Source
Sokol KC, Sharma G, Lin Y-L, Goldblum RM. Am J Med. 2015;128(5):502-508.
doi: 10.1016/j.amjmed.2014.12.006.
