Researchers at the University of Texas Medical Branch at Galveston have found that spirometry was underutilized from 2001 to 2011 to diagnose asthma and to manage adults in the United States, despite its cost effectiveness, accuracy and the recommendation of national guidelines that advocate its use. The study was published in the American Journal of Medicine.
Spirometry is a regular test that allows physicians to assess and determine how well the lungs of an individual work; the test consists of quantifying the amount of air inhaled and exhaled and how quickly it is exhaled, providing accurate measurements of air flows and volumes.
The Choosing Wisely initiative of the American Board of Internal Medicine Foundation supports both physicians and patients, working to provide effective, appropriate and cost-effective health care choices.
Asthma affects 8 percent of adults in the United States and represented a total of $56 billion in medical costs in 2007. Spirometry is recommended by The Choosing Wisely to follow-up and diagnose asthma care, representing $42 in costs per patient. In addition, when an inhaler is used unnecessarily it can lead to costs of $200 to $300 per month; an emergency room visit involving an asthma attack can cost up to $3,500. Hospitalizations and emergency visits are connected with how well the disease is controlled and spirometry can prevent expenses that are not required.
This study assessed trends from the period between 2001 and 2011 concerning the utilization of spirometry in the period of a year after an asthma diagnosis. A total of 134,208 asthma patients enrolled in the study, with the results demonstrating that 48 percent had preformed spirometry testing within the study period. The authors observed that younger male patients were more likely to receive spirometry and that 80 percent of patients cared for by specialists received spirometry. Nevertheless, even without spirometry, almost 80 percent of patients received a prescription of asthma drugs.
“Physicians must be educated about the usefulness of spirometry and given evidence of its medical and monetary value. As the Choosing Wisely initiative implies, the underuse of spirometry may lead to misdiagnosis or under diagnosis of asthma,” said Dr. Kristin Sokol, professor of allergy and immunology in pediatrics.