THE DIAGNOSTIC-APPROACH TO SUSPECTED ASTHMA IN A PRIMARY-CARE CENTER IN RIYADH

Background: Underdiagnosis of asthma is common in general practice. No studies to our knowledge have examined critically the General Practit ioner's (GP) approach to the diagnosis. Methods: A retrospective revie w of the medical records of 120 patients by: who were suspected to hav e asthma by GPs and referred to a pulmonary function laboratory for sp irometry over a three year period. Results: The symptoms suggestive of asthma were present for 1 to 520 weeks (mean 72). Many pertinent data were missing from the records; for example, history of wheeze and fam ily allergy were documented only in 32 (27%) and 16 (13%) respectively . Investigations requested on the initial visit, included: chest xray 89 (74%), eosinophil count 65 (54%), and serum IgE 7 (6%) with low dia gnostic yields. Of 99 patients who continued follow up, asthma was con firmed in 44 (44%), another diagnosis in 10 (10%), and 45 (46%) remain ed undiagnosed. Of the latter, only 6 were referred later for bronchop rovocation test and 3 to the pulmonary clinic, leaving over a third of patients without a specific diagnosis or treatment over the study per iod. Conclusion: While careful history taking and documentation is imp ortant, most of the tests with the exception of spirometry are probabl y not helpful, at least initially. Pursuing the diagnosis with definit ive tests such as bronchial or exercise challenge or referral to a pul monary clinic may be necessary in some patients with unexplained chron ic symptoms to confirm asthma or alert the GP to search for another di sease.