Chest
Volume 141, Issue 5, May 2012, Pages 1190-1196
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Original Research
Asthma
Pulmonary Function Testing in the Diagnosis of Asthma: A Population Study

https://doi.org/10.1378/chest.11-0831Get rights and content

Background

Asthma is a common chronic respiratory condition, the diagnosis of which depends on symptoms and objective evidence of variable airflow obstruction or airway hyperresponsiveness. The proportion of people who have had objective pulmonary function testing around the time of diagnosis and factors associated with receiving testing are not well understood.

Methods

A retrospective cohort study was conducted using the health administrative data of all individuals aged 7 years and older with newly physician-diagnosed asthma living in Ontario, Canada between 1996 and 2007. Receipt of pulmonary function testing in the peridiagnostic period was determined and examined across patient sociodemographic and clinical factors.

Results

Only 42.7% (95% CI, 42.6%-42.9%) of the 465,866 Ontarians newly diagnosed with asthma received pulmonary function testing between 1 year prior and 2.5 years following the time of diagnosis. In adjusted analyses, individuals 7 to 9 years old and those 70 years or older were less likely to receive testing than younger adults, individuals in the lowest neighborhood income quintile were less likely to receive testing than those in the highest, and individuals seeing a medical specialist were more likely to receive testing than those seeing only a general practitioner.

Conclusions

Less than one-half of patients with new physician-diagnosed asthma in Ontario, Canada received objective pulmonary function testing around the time of diagnosis. Further study is needed to determine why more pulmonary function testing is not being used to diagnose asthma and how barriers to its appropriate use can be overcome.

Section snippets

Materials and Methods

We conducted a longitudinal cohort study using health administrative data from Ontario, a province of Canada with universal health-care insurance and a diverse multicultural population of approximately 13 million.

Participants

There were 465,866 Ontarians aged 7 years and older who were diagnosed with asthma between 1996 and 2007. Characteristics of these individuals are presented in Table 1. The majority were under 40 years, were female, lived in an urban region, had a low to moderate amount of comorbidity, and had a specialist involved in their care.

Pulmonary Function Test Use Around the Time of Asthma Diagnosis

Approximately 42.7% of individuals (95% CI, 42.6, 42.9) underwent pulmonary function testing in the peridiagnostic period. Of these, 17.5% received a

Discussion

We conducted a study of all individuals living in Ontario, Canada with new physician-diagnosed asthma between 1996 and 2007 and found that only 42.7% received objective pulmonary function testing around the time of diagnosis. We also found young children and older adults, those who did not have a specialist involved in their care, and those of lower SES less likely to receive pulmonary function testing. Thus, it appears that most physician-diagnosed asthma in Ontario—a province with universal

Acknowledgments

Author contributions: Dr Gershon had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Dr Gershon: contributed to the conception and design, acquisition of data, analysis and interpretation of data, drafting and critical revision of the manuscript, and approval of the final version.

Mr Victor: contributed to the conception and design, analysis and interpretation of data, drafting and critical revision of the

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    Funding/Support: Dr Gershon was supported by an Ontario Ministry of Health and Long-Term Care Career Scientist Award. Dr To is supported by The Dales Award in Medical Research from the University of Toronto (Toronto, ON, Canada). Funding for this project was made available through the Government of Ontario. This study was also supported by the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care.

    Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).

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