Pediatricians Aren't Using Recommended Asthma Test

The guideline-recommended method to diagnose and manage asthma in children is underused by pediatricians, according to new research, which states that only 21% of doctors surveyed reported that they routinely use spirometry.

In the study, which was conducted by Kevin J. Dombkowski, DrPH, MS, and collagues from the University of Michigan, only half of the primary care physicians correctly interpreted spirometry results in a standardized clinical vignette, according to an online report.

“Previous studies suggest that doctors often underestimate asthma severity in the absence of spirometry results,” said Dombkowski. “The course of treatment may be altered substantially when spirometry information is made available,” he said. “The National Asthma Education and Prevention Program Expert Panel Report guidelines underscore the importance of spirometry in the initial diagnosis of asthma and at least once per year thereafter for ongoing management.”

As part of their research, Dombkowski and colleagues surveyed 360 general pediatricians and family physicians who treat children with asthma; they found that 52% of physicians used spirometry, while 80% reported using peak flow meters, which are not recommended due to their variable test results. Only 21% indicated that they routinely used spirometry to establish an asthma diagnosis, classify severity, and assess patients’ level of asthma control—the three clinical situations outlined in the national asthma guidelines. Use of spirometry was more common among family physicians than among pediatricians, they observed.

The study, which was published in Pediatrics, also found that only half of the surveyed physicians correctly interpreted the spirometry results from the clinical vignette, while 14% indicated that they did not know how to interpret the results.

More physicians under-rated the severity of an asthma case after interpreting spirometry results in conjunction with asthma symptoms. “This suggests that gaps exist in the application of spirometry results,” said Fauziya Hassan, MS, the study’s co-author. “Underrating asthma severity could lead to under-treatment of asthma, which has been linked to increased risk of serious asthma flare-ups.”

It is evident from the study, said Dombkowski, “that primary care physicians lack comfort and ability interpreting spirometry results. Additional training will be important for many pediatric primary care physicians and their staff members to promote widespread use of spirometry and to ensure correct interpretation of results.”

The authors believe that future studies should be conducted to determine the effectiveness of different types of spirometry training in pediatric primary care settings.

For more:

• Online CME: Asthma Gadgets 2010
• iMedicalApps.com: GPS-enabled Albuterol Inhaler Helps Patients Localize Their Asthma Triggers
• Code E876.9 Blog: I'm Not an Actor, and I Don't Play One in the Office