U-M research: Pediatricians don't use, can't interpret asthma test

Underuse could mean pediatricians are under-treating asthma patients

Kevin J. Dombkowski, DrPH, MS

The recommended method to diagnose and manage asthma in children is underused by pediatric primary care physicians, University of Michigan researchers have found.

Only 21 percent of doctors surveyed reported the routine use of the guideline-recommended method for assessing lung function known as spirometry.  Further, only half of the primary care physicians correctly interpreted spirometry results in a standardized clinical vignette. 

The findings appear online in the September issue of Pediatrics. Kevin J. Dombkowski, DrPH, MS, research associate professor with the Child Health Evaluation and Research (CHEAR) Unit within the University of Michigan Division of General Pediatrics, led the study.

"Previous studies suggest that doctors often underestimate asthma severity in the absence of spirometry results," says Dombkowski.  "The course of treatment may be altered substantially when spirometry information is made available. 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."

Researchers surveyed 360 general pediatricians and family physicians who provide care to children with asthma.  They found that 52 percent of physicians used spirometry, while 80 percent reported using peak flow meters, which are not recommended due to their variable test results. Only 21 percent 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. 

The study also found that only half of the surveyed physicians correctly interpreted the spirometry results from the clinical vignette, while 14 percent 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," say Fauziya Hassan, M.B.B.S., M.S.,clinical lecturer in the Department of Pediatrics and Communicable Diseases and 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 clear from this study that primary care physicians lack comfort and ability interpreting spirometry results," says Dombkowski.  "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."

Authors say future studies should be done to determine the effectiveness of different types of spirometry training in pediatric primary care settings.

In addition to Dombkowski and Hassan, co-authors are Elizabeth A. Wasilevich and Sarah J. Clark.

Funding source: The Blue Cross Blue Shield of Michigan Foundation funded this study. No financial disclosures.

Journal Reference: Pediatrics. DOI: 10.1542/peds.2010-0362

Written by Margarita Bauza Wagerson

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