*This Abstract was presented at the AOA National Convention, San Diego, CA, October 1, 2007
Abstract
Pulmonary function tests are routinely used to aid physicians in diagnosing asthma. This testing measures lung function by the volume and speed of air that can be inhaled and exhaled. The Bronx has many patients with asthma, yet how many of these people have ever had a pulmonary function test? It is important to correctly diagnosis asthma as misdiagnosis can lead to many problems for the patient including improper medical treatment, limitation of radiological contrast use, and failure to recognize other pulmonary pathologies. In a prospective study using a confidential questionnaire, we will determine how many patients have had a pulmonary function test and if there are any differences in testing among age, sex, race, who diagnosed the patient with asthma, and how many years the patient has had asthma. From the data collected, it was determined that 52.9% of patients had a pulmonary function test. There was a significant difference in receipt of this test for people over age 35.5 and that had asthma longer than 30 years. From this study, we are able to conclude that a decrease in age is associated with less use of pulmonary function tests and that approximately half of the patients in the Bronx that have a diagnosis of asthma have not been properly tested.
Introduction
The purpose of this study is to determine the prevalence of inner city Bronx patients treated for acute asthma exacerbation that have not had a pulmonary function test. It is estimated that nationally, one out of fifteen people have asthma. Each year asthma accounts for around two million emergency room visits. Yet with such a prevalence of asthma, are current diagnosis and treatment actually dealing with asthma, or merely assigning common symptoms of asthma the title because of its prevalence? The Bronx has one of the highest proportions of asthma in the country and three times the national average of deaths from asthma, yet is the diagnosis of asthma made correctly according to current standards? In a prospective study of inner city Bronx patients that were treated in the emergency department for an acute asthma exacerbation, we can see how many of such patients have had a pulmonary function test. Determining how many people diagnosed with asthma in one of the most prevalent areas where the disease is found allow us insight as to whether the large numbers and treatment of asthma is accurate or whether the high statistics is due to a lack of various testing in the diagnosis.
Methods
We enrolled 384 patients in a prospective study of adults that were treated in the emergency room for an acute asthma exacerbation over the period of January 2006 through April 2007. Patients were eighteen years or older and of various ethnic backgrounds. A confidential questionnaire was distributed inquiring age, sex, race, if the patient had ever had a pulmonary function test, who initially diagnosed the patient with asthma, and how many years the patient has had asthma. Twenty-one patients were excluded for incomplete questionnaires or consent.
Results
Of the 363 patients treated for asthma, 192 (52.9%) had received a pulmonary function test, but 171 (47.1%) had not, approximately half those seen.
Conclusion
There was no difference in receipt of a pulmonary function test by gender, by race, or by who told the patient he/she had asthma, but there is a trend for age of patient and duration of illness that indicates a decrease in diagnosis with pulmonary function test over time (see following tables and bar charts). Almost 2/3 of patients with asthma for over 30 years had received a pulmonary function test , but the proportions were more even for those suffering for fewer than 30 years. This is also demonstrated in an analysis by age: a decrease in age is associated with less use of the pulmonary function test. A split at age=35.5 yielded a Chi Square of 8.45, p<.01, for the cross tabulation of age with pulmonary function test (see below).
Discussion
Being that the standard of care for diagnosis of asthma is testing with pulmonary function tests, we were able to conclude that approximately half of patients with this diagnosis were not properly tested. This study provides a good basis for future research and determining if those with a presumptive diagnosis of asthma were properly diagnosed. While we are able to conclude that a decrease in age is associated with less use of pulmonary function tests, there are certain limitations to this study. There was a limited amount of questions in which this data was based. Also, the survey was based on the patient’s understanding of what a pulmonary function test was and how it was administered. Individual patient’s recall of diagnosis may also have been biased. This study was also limited to one specific hospital and patient population.
| PULMONARY FUNCTION TEST | |||||
|---|---|---|---|---|---|
| NO | YES | TOTAL | |||
| Age | 18-25 | Count | 34 | 25 | 59 |
| % within Age | 57.6% | 42.4% | 100.0% | ||
| 26-35 | Count | 40 | 30 | 70 | |
| % within Age | 57.1% | 42.9% | 100.0% | ||
| 36-45 | Count | 49 | 52 | 101 | |
| % within Age | 48.5% | 51.5% | 100.0% | ||
| 46-55 | Count | 37 | 39 | 76 | |
| % within Age | 48.7% | 51.3% | 100.0% | ||
| 56-65 | Count | 6 | 34 | 40 | |
| % within Age | 15.0% | 85.0% | 100.0% | ||
| 66-75 | Count | 4 | 10 | 14 | |
| % within Age | 28.6% | 71.4% | 100.0% | ||
| 76-85 | Count | 1 | 2 | 3 | |
| % within Age | 33.3% | 66.7% | 100.0% | ||
| Total | Count | 171 | 192 | 363 | |
| % within Age | 47.1% | 52.9% | 100.0% | ||
| VALUE | DF | ASYMP. SIG. (2-SIDED) | |
|---|---|---|---|
| Pearson Chi-Square | 24.314(a) | 6 | .000 |
| Likelihood Ratio | 26.369 | 6 | .000 |
| N of Valid Cases | 363 | ||
| A 2 Cells (14.3) have expected count less than 5. The minimum expected count is 1.41.
|
|||
Bibliography
-
Asthma at a Glance, National Center for Environmental Health (NCEH), U.S. CDC, 1999.
-
New Asthma Estimates: Tracking Prevalence, Health and Mortality, NCHS, CDC, 2001.
-
Guidelines for the Diagnosis and Management of Asthma. National Asthma Education Program Expert Panel Report, US Department of Health and Human Services, NIH publication 91-3042, 1991.
-
Kelly MA, Powell CVE, Kerr D. Lack of agreement in classification of the severity of acute asthma between physician assessment and classification according to the National Asthma Council Guidelines (Australia). Academic Emergency Medicine. 2001; 5:514.
-
Al-Mutairi SS, Sugathan TN. Utilization of the pulmonary function test laboratory in the evaluation of respiratory disorders in the Al-Amiri Hospital: a secondary medical center. Med Princ Pract. 2005; 14:182-8.
-
Akoglu S. Topacoglu H, Karcioglu O, Cimrin AH. Do the residents in the emergency department appropriately manage patients with acute asthma attack? A study of self-criticism. Adv Ther. 2004; 21:348-56.