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

Personalised Puffers: Asthma’s Exciting Future

Children with asthma could soon get personalized treatment that targets their specific type of wheeze, a world-leading respiratory expert says.

British paediatric allergy researcher Professor Adnan Custovic will deliver a lecture in Sydney on Friday on ground-breaking work that could see youngsters one day diagnosed with distinct types of asthma. Once specialists are able to diagnose sub-types of the common lung condition, work can get underway to personalise treatment for each patient, ensuring sufferers get the most effective therapy for their specific wheeze.

The Woolcock Institute of Medical Research in Sydney invited the distinguished researcher to Australia to present the Ann Woolcock Lecture in honour of the institute’s esteemed founder.

More than two million Australians have asthma, and rates are highest in children,”  says the Woolcock’s Executive Director Professor Carol Armour. “Doctors currently only have the ability to diagnose and treat asthma broadly, so to consider a future with targeted treatments is truly exciting.

Asthma is an umbrella term for a collection of distinct diseases in which the airways become narrow and inflamed. Researchers worldwide are working with reams of genetic and environmental data to discover specific asthma subtypes. Professor Custovic, Clinical Professor of Paediatric Allergy at Imperial College, London, will report on exciting developments in machine-learning techniques to advance the field. 

Professor Armour says if advancements keep up, one day soon our doctors will be able to identify true asthma endotypes at a population level. "This will ultimately lead to more precise prevention strategies, identification of novel therapeutic targets and the development of effective personalized therapies,” she says.

The Ann Woolcock Lecture series honours the contribution of Prof Woolcock to the research community. Invited researchers share their ideas with industry, policy makers, doctors, specialists and patients with a view to prompting new collaborations to improve respiratory health.

The lecture will be held on Friday, 28 October at 5.30pm, at the Woolcock Institute of Medical Research headquarters in Glebe, Sydney.

RSVP to woolcock.admin@sydney.edu.au or phone 02 9114 0408.