THE USE OF OBJECTIVE MEASURES OF ASTHMA SEVERITY IN PRIMARY-CARE - A REPORT FROM ASPN

Background. The rising incidence of and mortality from asthma have pro mpted the development of practice guidelines for diagnosis and managem ent. A corner-stone of these guidelines is the use of objective measur es of asthma severity: spirometry or peak expiratory flow rates. We st udied the extent to which primary care clinicians used objective measu res of asthma severity. Methods. Practices affiliated with the Ambulat ory Sentinel Practice Network in the United States and Canada collecte d data on 490 asthma-related encounters involving 439 patients. For ea ch encounter, the practice recorded the availability of the results of spirometry, peak expiratory flow rates, oxygenation (arterial blood g as or pulse oximetry), and chest radiograph to the clinician. Results. Objective data about asthma severity were infrequently available to A SPN clinicians at the time of the encounter. In 67.8% of encounters, t here was no current or past spirometry result, in 55.1% there was no c urrent or past peak flour measurement, and in 74.3% there was no curre nt or past determination of oxygenation. Chest radiographs, on the oth er hand, were available for most (64.7%) patients. The lack of objecti ve measures was not related to lack of access to the relevant technolo gies. Most practices noted easy access to spirometry (72.2% of practic es), peak flow meters (72.2%), oxygenation determination (61.1%), and radiography (83.3%). Conclusions. In this study, most primary care cli nicians did not have objective data about the severity of their patien ts' asthma at the time of the encounter. This relative lack of objecti ve data was not explained by lack of access to the relevant technology for determining severity. It may instead reflect the opinion of prima ry care physicians that such information is not necessary in the care of these patients.