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Commentary

Pharmacist Intervention in Physician-Diagnosed Asthma


January 25, 2017

Asthma is one of the leading respiratory abnormalities worldwide, accounting for approximately 334 million patients. 1 Traditionally, pharmacists assist healthcare providers in optimizing drug therapy choices for asthma based upon degree of airflow limitations, insurance coverage, and the ability of using a respiratory device correctly.  In addition, pharmacists have assisted in other measures including education of the disease, smoking cessation and use of peak flow measuring devices. Pharmacists do not have an active role in the diagnosis of the disease and usually respond to recommending drug therapy based upon a physician diagnosis. However, some practices have included pharmacists in spirometry testing to assist physicians in diagnosis of the disease. 2
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A recent study identified that about one-third of patients diagnosed with asthma actually do not have the disease. A prospective, randomized study was conducted at 10 Canadian cities from 2012-2016 to recruit patients with a physician-diagnosed asthma. Information on patient diagnoses was obtained by the physician who diagnosed the patient. Patients were assessed by peak flow monitoring, spirometry testing, and bronchial provocation testing. A total of 613 patients completed the study. Current asthma was ruled out in 203 of 613 patient (33%). After an additional 12 months of follow-up, 181 participants (29.5%) continued to exhibit no clinical or laboratory evidence of asthma. 3

In my own experience working with asthma patients, I would agree with these findings. In a previous work at our pharmacist-driven spirometry clinic, only 8 of 14 patients (57%) prescribed a bronchodilator required it to be discontinued, ruling out reactive airway disease (asthma). 2 The study by Aaron et al demonstrates that many patients are misdiagnosed with asthma. Therefore, pharmacists should have a more active role in spirometry testing to help clarify a diagnosis or recommend bronchial provocation testing. The result would be a more accurate diagnosis so pharmacological therapy can be better utilized. Accepting a diagnosis from a physician without the proper diagnostic testing may result in incorrect or potentially harmful prescribing.

References

  1. The Global Asthma Report 2014. http://www.globalasthmareport.org/burden/burden.php.
  2. Cawley MJ, Pacitti R, Warning W. Assessment of a pharmacist-driven point-of-care spirometry clinic within a primary care physicians office. Pharmacy Practice (Granada) 2011;9(4):221-227.
  3. Aaron SD, Vandemheen KL, FitzGerald JM. Reevaluation of diagnosis in adults with physician diagnosed asthma. JAMA 2017;317(3):269-279.
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