- Page navigation anchor for RE:Choosing a wise approach for asthma and COPD diagnosis in primary care.RE:Choosing a wise approach for asthma and COPD diagnosis in primary care.
I would like to congratulate Dr. Gupta for his excellent article (Choosing Wisely Canada) (1) pertaining to diagnosing asthma and chronic obstructive pulmonary disease and the importance of pulmonary function testing in this context. I have had the pleasure of working with Dr. Gupta in areas dealing with this subject and I have learned a great deal from him about the challenges that we face when it comes to diagnosing asthma and chronic obstructive pulmonary disease (COPD) in the primary care setting. I would like to take this opportunity to highlight how making choices about approaches to diagnosis of asthma and COPD might be influenced differently based on available data and how it may or can be applied in the real-world setting. Dr. Gupta does an eloquent job in highlighting the underutilization of spirometry in primary care for objective diagnosis of both asthma and COPD and how this gap may influence patient management.
Dr. Gupta highlights that Canadian Thoracic Society Guidelines related to asthma diagnosis and management suggest that simple spirometry should be a first line test and that asthma diagnosis should include demonstration of a reduction in FEV1/FVC ratio and an improvement in FEV1 of at least 12% and 200 mL. Those patients who fail to demonstrate a positive bronchodilator response will then undergo further evaluations including methacholine challenge testing (MCT). The fact that MCT is a more sophisticated test and difficult to obtain in some si...
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