Columbus, OH - March 2016
Pulmonary function tests (PFTs) are used to objectively assess asthma control in an outpatient setting. In only five minutes, a provider can have the data needed to analyze the amount of swelling present in a patient’s airway, thus getting a good picture of how well the asthma is controlled. Using the data obtained in a PFT, the physician can make asthma management decisions.
During a PFT — also known as spirometry — the patient breathes into a mouthpiece attached to a machine that measures the quantity of air and the force with which the air is blown. Often, an initial PFT is done, then albuterol is administered and a repeat PFT is performed. This enables the administering physician to get a true baseline of pulmonary function.
While there is some training involved and initial cost to obtain the spirometer, the difference in outcomes for patients could be dramatic.
“Asking a patient or parent how well asthma is controlled results in a subjective assessment that is not always accurate,” explains Dane Snyder, MD, physician in the Section of Ambulatory Pediatrics at Nationwide Children’s Hospital. “In some cases, kids get used to feeling a certain way and don’t realize that they could be feeling a lot better. We tend to get a lot of teens who say that they are doing great, but when you do the PFT, the numbers indicate otherwise.”
According to the Centers for Disease Control and Prevention, asthma occurs in about 9 percent of children in the United States. That’s about 7 million children. The Ohio Department of Health estimates that as many as 20 percent of children in Franklin County have asthma, says Dr. Snyder. Emergency department visits for asthma are also on the rise, indicating a need to continue improving asthma care.
“PFTs are an invaluable tool for patients,” says Dr. Snyder, who is also clinical associate professor of Pediatrics at The Ohio State University College of Medicine. “They are one of the reasons we have been able to see such improved outcomes in our office’s asthma patients.”
The National Heart, Lung, and Blood Institute (NHLBI) guidelines recommend that PFTs be done every one to two years for all patients with asthma, or at every visit until control is reached. These guidelines are further supported by research showing that regular PFTs reduce the risk of hospitalization.
“In offices and clinics where PFTs are not available, patients should be referred to a pulmonologist for testing. However, since PFTs can be done easily in the primary pediatrician’s office, we see a great benefit to having them do these tests,” says Karen McCoy, MD, chief of Pulmonary Medicine. “Attending additional appointments, missing work and school, and paying for additional copays are all deterrents and barriers to care for many patients with asthma.“
Currently, only about 35 percent of outpatient offices nationally use PFTs at all. According to a national study in the journal Pediatrics, only 20 percent are using PFTs routinely. Nationwide Children’s Section of Pulmonary Medicine wants to change that by offering training, tools and support for primary care offices interested in adding PFTs to their arsenal of care for patients with asthma.
Moth G, Schiotz PO, Parner E, Vedsted P. Use of lung function tests in asthmatic children is associated with lower risk of hospitalization. A Danish population-based follow-up study. Journal of Asthma. 2010 Nov;47(9):1022-1030.
Dombrowski KJ, Hassan F, Wasilevich EA, Clark SJ. Spirometry use among pediatric primary care physicians. Pediatrics. 2010 Oct;126(4):682-687.