SAN DIEGO — “It’s very important that we know how to correctly diagnose this disease,” began nurse practitioner, Mary Lou Hayden, RN, MS, FNP-BC, AE-C, referring to the disease of asthma. She explained that correct diagnosis is important partly because the disease is so common, affecting 7.6% of adults and 8.4% of children in the United States, and partly because it is responsible for significant health care utilization, including 6.5% of office visits and 1.6 million emergency department visits.
Correctly and objectively diagnosing asthma is also important, Hayden continued in a presentation at the annual Cardiology, Allergy, and Respiratory Disease Summit, because, “We cannot simply rely upon patients’ reports of symptoms. Patients very frequently underreport their symptoms and don’t assume it’s asthma.” She says that while peak flow meters can be helpful, they are not diagnostic. “It’s important that we have objective measures . . . and the most important measure is spirometry.”
“You can buy a small office spirometer for as little as $1000,” Hayden continued at the conference, held by Global Academy for Medical Education, “and as a reimbursable procedure, it pays for itself in a short period of time.” “It actually becomes a revenue center for the practice,” she added.
She explained that she’s seen patients with supposed uncontrolled asthma referred to her practice who don’t, in fact, have asthma at all. “If the [referring] office had had a spirometer, they would have perhaps not needed to refer.”
So important is spirometry to the diagnosis and management of asthma that Hayden offers an annual pre-conference workshop on the test, so that “NPs and PAs can leave the conference having all the tools they need to optimize treatment.”
Selecting therapy
Hayden explained that because the US National Asthma Education and Prevention Program Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (https://www.nhlbi.nih.gov/files/docs/guidelines/asthgdln.pdf), commonly known as NAEPP or EPR-3, haven’t been updated since 2007, that it’s important to look to the Global Initiative for Asthma: Global Strategy for Asthma Management and Prevention (GINA) (https://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/), 2018, which is updated annually, for treatment guidance.
For example, personalized or precision medicine is now heavily influencing the field of asthma. Phenotypes, endotypes, and genotypes are helping to guide treatment of severe asthma with monoclonal antibodies and other therapeutic agents, remarked Hayden.
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