Asthmatics Miss Out on Crucial Lung Tests: Report

Most Australians with asthma and other lung conditions are missing out on lung tests needed to properly diagnose their condition, a new report reveals.

Spirometry lung function tests are recommended to ensure the millions of Australians with breathing disorders are correctly diagnosed around the time they start medication. However, a report produced by the Australian Centre for Airways disease Monitoring (ACAM) at the Woolcock Institute of Medical Research shows these tests are rarely performed.

We discovered that 82 per cent of people on medication to treat chronic airways disease, including asthma and chronic obstructive pulmonary disease (COPD), did not have their lung function tested within 12 months before or after their initial prescription,” says Woolcock respiratory physician Professor Helen Reddel. “That is very concerning given research shows these tests are needed to ensure people are correctly diagnosed.

The report is a collaboration of ACAM and the Australian Institute of Health and Welfare supporting the national monitoring of chronic respiratory conditions. It analyses data collected as part of the Sax Institute’s 45 and Up Study of more than 250,000 NSW residents.

The work investigates the use of spirometry, a type of lung function test that assesses how well the lungs are working, which is regarded an essential part of diagnosing and managing chronic airways disease.

As Professor Reddel explains, guidelines for asthma and COPD recommend that spirometry be performed to confirm the diagnosis before treatment is started, or soon after. “Unfortunately, in most cases this is not happening,” she says.

For asthma in particular, once the disease is diagnosed it’s recommended that lung function be measured again periodically, every 1–2 years for most patients. “But we found that lung function testing was performed for only about one-quarter of asthma patients in a three-year period, and 12 per cent had only one lung function test during that time,” the physician says. “There are serious concerns the lack of testing may be contributing to inaccurate diagnosis and inappropriate use of medicines.

Researchers believe the findings may reflect difficulties for the medical community in carrying out spirometry tests in primary care, including insufficient Medicare reimbursements, the need for careful staff training, and on-the-job time constraints.

The results support findings from the recent Medicare Benefits Schedule Review, for which the Thoracic Medicine Clinical Committee noted underuse of lung function testing in primary care and recommended changes in order to increase its use for diagnosis and management of asthma and COPD.

The report, The use of lung function testing for the diagnosis and management of chronic airways disease: Demonstration data linkage project using the 45 and Up Study 2001–2014, can be found by clicking this link: http://www.aihw.gov.au/publication-detail/?id=60129557382