Evaluation of the severity of asthma: Patients versus physicians

doi:10.1016/0002-9343(80)90155-2

The American Journal of Medicine

Volume 68, Issue 1, January 1980, Pages 11-13

https://doi.org/10.1016/0002-9343(80)90155-2 Get rights and content

Abstract

It is clear that accurate assessment of the severity of asthma requires a measurement of airway obstruction, such as peak expiratory flow rate. In this study, physicians were quite inaccurate in estimating the peak expiratory flow rate by examining patients, whereas the patients themselves were far more accurate in guessing the measurement. In addition, they were able to tell whether the peak expiratory flow rate was better, the same or worse from day to day. Patients' symptoms are important indices of the severity of airway obstruction which should be exploited in management.

References (10)

C Shim et al.
Pulsus paradoxus in asthma
Lancet
(1978)
SG Kelsen et al.
Emergency room assessment and treatment of patients with acute asthma
Am J Med
(1978)
AR Rubinfeld et al.
Perception of asthma
Lancet
(1976)
S Godfrey et al.
Repeatability of physical signs in airways obstruction
Thorax
(1969)
ER McFadden et al.
Acute bronchial asthma
N Engl J Med
(1973)

There are more references available in the full text version of this article.

Cited by (142)

Life Threatening Asthma
2021, Encyclopedia of Respiratory Medicine, Second Edition
Pulmonary Function Testing
2015, Murray and Nadel's Textbook of Respiratory Medicine: Volume 1,2, Sixth Edition
Perception of bronchodilation assessed by Visual Analogue Scale in children with asthma
2013, Allergologia et Immunopathologia
Citation Excerpt :
VAS was also considered useful in assessing symptom severity when compared with lung function testing.3 On the other hand, physical findings may be inadequate for assessing bronchial obstruction and remarkable airway obstruction may be present despite a normal clinical examination.14 Therefore, lung function assessment remains the best way to detect airflow obstruction.
Visual Analogue Scale (VAS) has been proposed as a useful tool for assessing the perception of asthma symptoms, a cornerstone in disease management. While airway flow limitation and its reversibility are thought to be a useful marker of disease severity, there are very few studies that evaluated the response to bronchodilation (BD) testing perception by VAS. To investigate whether VAS assessment of breathlessness perception could provide a useful tool to assess the response to BD testing in asthmatic children.
This cross-sectional study included a total of 150 children (96 males, mean age 11.05 years) with asthma, 50 had bronchial obstruction (i.e. FEV₁ <80% of predicted). Perception of breathlessness was assessed by VAS; lung function was measured by spirometry. BD testing was performed in all children.
In children with bronchial obstruction, VAS at baseline was 4.7 and significantly increased to 6.9 (p < 0.001) after BD. In children without bronchial obstruction, VAS at baseline was 7.4, but further significantly increased to 8.4 after BD testing (p < 0.01). There was a significant difference in Δ VAS between children with bronchial reversibility and children without it (p < 0.0001).
The present study demonstrates that VAS might be considered an initial tool to assess the BD response in children with asthma, mainly with overt bronchial obstruction.
Asthma in Nigeria: Are the facilities and resources available to support internationally endorsed standards of care?
2011, Health Policy
Citation Excerpt :
These results show that most hospitals were not adhering to this recommendation on oxygen therapy which is an important aspect of asthma therapy. In an acute care setting that is often involved in the management of asthma exacerbations, functional assessments such as measurement of PEFR or force expiratory volume in one second (FEV1) and arterial oxygen saturation measurements by pulse oximetry are strongly recommended as physical examination alone may not fully indicate the severity of the exacerbation, particularly the degree of hypoxemia [1,20,21]. Furthermore, 41.2% of the selected hospital had access to a nebuliser and 20.6% to spacer.
The objective of this study was to assess the facilities and resources available to support internationally endorsed standards of asthma care at tertiary hospitals (University teaching, Federal Medical Centre and State specialist Hospitals) in Nigeria.
This cross sectional study was conducted among 68 tertiary hospitals (TH) in Nigeria from June 2009 to December 2009. Structured standards of care questionnaires on asthma based on the Global initiative for asthma (GINA) guideline were completed by physician working in each of the TH.
Most TH lacked the services of respiratory physicians, internists, and pediatricians. Available basic infrastructures were asthma clinics (0%), clinic registers (20.6%), and hospital protocol (17.6%), doctor's attendance of asthma CME (8.8%) and nurse educator with a bias for asthma (14.7%). Thirty eight percent of TH had peak flow meter, 29.4% had spirometer, skin allergy test kits (15.6%), pulse oximeter (38.2%) while 17.6% had arterial blood gases analyser. Nebuliser and spacer were available in 41.2% and 20.6% of TH respectively. Oral short acting beta 2 agonist (SABA) was available in 79.4% of the hospitals, glucocorticosteroid (79.4%), theophyllines (76.5%), and SABA (metered-dose inhaler MDI: 76.5%, Nebules: 35.3%). Long acting beta 2 agonist (LABA) and steroid fixed dose combination inhaler (50%) was available in 50% of TH. Glucocorticosteroid nasal spray was available in 33.3% of TH and <10% reported the availability of anti-cholinergic and chromoglycate inhaler and oral leukotriene antagonist. Standard oxygen delivery system and self-educational support materials were available in 52.9% of TH.
The available facilities and human resources for asthma management in Nigerian tertiary hospitals were not enough to support the standard internationally endorsed for asthma care. Provisions of deficient infrastructures and continuous training of health care personnel in asthma management are imperative to enhance the quality of care.
Asthma
2007, Comprehensive Pediatric Hospital Medicine
The influence of pulmonary function testing on the management of asthma in children
2005, Journal of Pediatrics
Citation Excerpt :
This study shows that even subspecialty providers tend to underestimate the degree of airway obstruction in children with asthma. These results are similar to those found in a group of pulmonologists studying adults with stable asthma.12 The FEV1 is considered the “gold standard” in measuring airway obstruction, because its measurement has been well established.17
To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.
Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented.
Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy.
Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.

View all citing articles on Scopus

¹: From the Pulmonary Division, Department of Medicine, Albert Einstein College of Medicine, and the Chest Service, Department of Medicine, Bronx Municipal Hospital Center, Bronx, New York.

View full text

Clinical studyEvaluation of the severity of asthma: Patients versus physicians

Abstract

Lancet

Am J Med

Lancet

Repeatability of physical signs in airways obstruction

Thorax

Acute bronchial asthma

N Engl J Med

Clinical study
Evaluation of the severity of asthma: Patients versus physicians