Improving the diagnosis of asthma in a primary care practice

31 patients had PFTs; 24 had MCs: a substantial investment of patient time and a substantial cost to the taxpayers of Ontario (and we haven't considered the opportunity costs incurred by those who needed the PFT tests and who were delayed by this exercise).

How many of 66 unconfirmed 'asthmatics' had one episode of wheezing in the preceding four years but no recurrence? How many were athletes who can exercise better if they take an anticipatory spray of salbutamol? Why would we need to confirm the diagnosis in these cases?

And what were the results that might lead to improved patient outcomes?

Did patients who were confirmed to have asthma have changes in their medication? Or did they just continue the medication they used, either chronically or intermittently?

Of those who did not have asthma, were any actually taking chronic medication that was stopped? All had been previously treated, so we could have asked if the treatment had improved their condition. No surprise if it didn't, but what was the actual diagnosis if treatment had helped? Have any of those patients had recurrences where a treatment response was demonstrated?

I am sure there are conditions where quality improvement processes are valuable in improving patient outcomes. If the authors had looked at those patients who were using asthma medications chronically and confirmed that all actually had asthma, this might have been a useful exercise.

I am not convinced that this particular project demonstrated anything other than the good sense of the 53% of patients who declined the invitation.

Conflict of Interest:

None declared