UTMB study shows cost-effective expert recommended asthma test underutilized by physicians

Researchers from the University of Texas Medical Branch at Galveston have found, for the first time, that spirometry was underutilized for asthma diagnosis and management in U.S. adults from 2001 to 2011, despite it's accuracy, cost effectiveness and the publication of national guidelines advocating its use.

Spirometry is a common test that allows physicians to determine how well a person's lungs work by measuring how much air is inhaled and exhaled as well as how quickly the air is exhaled. This test plays a vital role in the diagnosis and management of asthma by providing accurate measurements of air volumes and flows.

The Choosing Wisely initiative of the American Board of Internal Medicine Foundation helps physicians and patients work together to make appropriate, effective and cost-effective health care choices.

Asthma affects about 8 percent of U.S. adults, which cost $56 billion in medical care in 2007. The Choosing Wisely initiative recommends spirometry for diagnosis and follow-up asthma care because it's effective and costs about $42.

On the other hand, unnecessary use of an inhaler can cost $200 to $300 a month. An emergency room visit for an asthma episode can total $3,500. Health care use, including emergency department visits and hospitalizations are linked with how well asthma is controlled. Thus, when used in the diagnosis and management of asthma at the recommended times, spirometry should prevent needless expense.

This study evaluated trends, from 2001 to 2011, in the use of spirometry in patients within a year of when they were diagnosed with asthma. The findings are detailed in the American Journal of Medicine.

In all, 134,208 asthma patients were included in the study. Only 48 percent had spirometry performed within one year of diagnosis. Younger patients, males and those residing in the Northeast were more likely to receive spirometry. Eighty percent of patients cared for by specialists received spirometry, while only 23 percent of those cared for by primary care physicians underwent the test. However, even without spirometry, close to 80 percent of patients were prescribed asthma drugs.

"Physicians must be educated about the usefulness of spirometry and given evidence of its medical and monetary value," said Dr. Kristin Sokol, assistant professor of pediatrics in the division of allergy and immunology. "As the Choosing Wisely initiative implies, the underuse of spirometry may lead to misdiagnosis or under diagnosis of asthma."

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This paper was supported by the University of Texas Systems Health IT and Systems Engineering.

Other authors of this paper include UTMB's Gulshan Sharma, Yu-Li Lin and Randall Goldblum.

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Donna Ramirez

donna.ramirez@utmb.edu409-772-8791