Citation Information :
Nwosu NI, Chukwuka CJ, Onyedum CC, Odilinye HC, Nlewedim PI, Ayuk AC. The Utility of Spirometry in Assessment of Presumptive Diagnosis of Bronchial Asthma in a Nigerian Tertiary Hospital. Indian J Respir Care 2019; 8 (2):102-106.
Context: Spirometry with reversibility testing is the gold standard for definitive diagnosis of bronchial asthma. However, even in those with established bronchial asthma reversibility test result may subsequently become negative. Spirometry results may also be normal during exacerbation-free intervals.
Aims: This study assessed the role of spirometry in diagnostic evaluation of bronchial asthma and determined the ventilatory patterns of patients with presumptive diagnosis of bronchial asthma using spirometry and the proportion of those who showed positive reversibility test.
Patients and Methods: This was a retrospective study carried out at a teaching hospital in Nigeria. This was an audit of consecutive patients with presumptive diagnosis of asthma referred for spirometry between January 2013 and June 2015. Spirometer with disposable mouthpieces, stadiometer, and salbutamol inhalers were used. The statistical analysis was done with Statistical Package for the Social Sciences version 20.
Results: Eighty-nine participants did spirometry of whom 28 (31.5%) had additional postbronchodilator testing. Fifty (56.3%) participants were females (mean age of 42.17 ± 15.48 years). Normal, obstructive, restrictive, and mixed ventilatory patterns were found in 39 (43.8%), 31 (34.8%), 10 (11.2%), and 9 (10.1%) participants, respectively. Positive reversibility test result occurred in 15 (53.6%) participants, 9/19 obstructive (47.4%), and 6/9 mixed patterns (66.7%).
Conclusion: Only a few patients with presumptive diagnosis of asthma were confirmed by spirometry. Spirometry is useful in asthma diagnosis, but clinicians should be aware of its limitations in diagnostic assessment. Although asthma is typically associated with obstructive spirometry, other spirometry patterns can occur.
Oni AO, Erhabor GE, Egbagbe EE. The prevalence, management and burden of asthma - A Nigerian study. Iran J Allergy Asthma Immunol 2010;9:35-41.
Global Asthma Network. Global Asthma Report; 2014. Available from: Replace highlighted text with http://www.globalasthmanetwork.org/publications/Global_Asthma_Report_2014.pdf. [Last accessed on 2018 Aug 09].
Ayuk A, Iloh K, Obumneme-Anyim I, Ilechukwu G, Oguonu T. Practice of asthma management among doctors in South-Eastern Nigeria. Afr J Respir Med 2010;6:14-7.
British Thoracic Society, Scottish Intercollegiate Guidelines Network. British Guideline on the Management of Asthma: A National Clinical Guideline. Edinburgh, UK: National Health Service Quality Improvement Scotland; Thorax 2018;63 Suppl 4:iv1-121. doi: 10.1136/thx.2008.097741.
Aaron SD, Vandemheen KL, Boulet LP, McIvor RA, Fitzgerald JM, Hernandez P, et al. Overdiagnosis of asthma in obese and nonobese adults. CMAJ 2008;179:1121-31.
Metha C, Migliore C, Rezai F, Patel L, Anandarangam T, Karetzky M. Over-diagnosis of asthma and its relationship to body mass index. Chest 2006;130:97S.
Koffi N, Kouassi B, Ngom AK, Kone MS, Danguy EA. Evaluation of management of asthma African adults. National survey among general physicians from Ivory Coast. Rev Mal Respir 2001;18:531-6.
National Asthma Education and Prevention Program. Expert panel report 3 (EPR-3): Guidelines for the diagnosis and management of asthma-summary report 2007. J Allergy Clin Immunol 2007;120:S94-138. Erratum in: J Allergy Clin Immunol 2008;121:1330.
Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, et al. An Official American Thoracic Society/European Respiratory Society Statement: Asthma control and exacerbations: Standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009;180:59-99.
Walker PP, Mitchell P, Diamantea F, Warburton CJ, Davies L. Effect of primary-care spirometry on the diagnosis and management of COPD. Eur Respir J 2006;28:945-52.
Oni OA, Erhabor GE, Oluboyo PO. Does health-related quality of life in asthma patients correlate with the clinical indices? S Afr Fam Pract 2014;56:133-8.
Desalu OO, Salami AK, Fawibe AE, Oluboyo PO. An audit of spirometry at the university of Ilorin teaching hospital, Ilorin, Nigeria (2002-2009). Ann Afr Med 2010;9:147-51.
Adeyeye OO, Bamisile RT, Brodie-Mends AT, Adekoya AO, Bolarinwa FF, Onadeko BO, et al. Five-year audit of spirometry at the LASUTH, Ikeja, South-West Nigeria. Afr J Respir Med 2012;8:15-7.
Onyedum CC, Chukwuka CJ. Indications for spirometry at a tertiary hospital in South East, Nigeria. Niger J Clin Pract 2009;12:229-31.
Osaretin OW, Uchechukwu ND, Osawaru O. Asthma management by medical practitioners: The situation in a developing country. World J Pediatr 2013;9:64-7.
Global Initiative for Chronic Obstructive Lung Disease. Global Strategy for the Diagnosis, Management, and Prevention of Chronic Obstructive Pulmonary Disease; Am J Respir Crit Care Med 2007;176:532-55.
Pellegrino R, Viegi G, Brusasco V, Crapo RO, Burgos F, Casaburi R, et al. Interpretative strategies for lung function tests. Eur Respir J 2005;26:948-68.
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J 2005;26:319-38.
Miller A, Palecki A. Restrictive impairment in patients with asthma. Respir Med 2007;101:272-6.
Decramer M, Janssens W, Derom E, Joos G, Ninane V, Deman R, et al. Contribution of four common pulmonary function tests to diagnosis of patients with respiratory symptoms: A prospective cohort study. Lancet Respir Med 2013;1:705-13.
Schneider A, Gindner L, Tilemann L, Schermer T, Dinant GJ, Meyer FJ, et al. Diagnostic accuracy of spirometry in primary care. BMC Pulm Med 2009;9:31.
Onyedum C, Ukwaja K, Desalu O, Ezeudo C. Challenges in the management of bronchial asthma among adults in Nigeria: A systematic review. Ann Med Health Sci Res 2013;3:324-9.
Peacock JL, Peacock PJ. Oxford Handbook of Medical Statistics. 1st ed. New York: Oxford University Press Inc.; 2013. p. 234.
Kaplan A, Stanbrook M. Must family physicians use spirometry in managing asthma patients? YES. Can Fam Physician 2010;56:126, 128, 130,132.
Hunter CJ, Brightling CE, Woltmann G, Wardlaw AJ, Pavord ID. A comparison of the validity of different diagnostic tests in adults with asthma. Chest 2002;121:1051-7.
Hegewald MJ, Townsend RG, Abbott JT, Crapo RO. Bronchodilator response in patients with normal baseline spirometry. Respir Care 2012;57:1564-70.
Enright PL, Studnicka M, Zielinski J. Spirometry to detect and manage chronicobstructive pulmonary disease and asthma in the primary care setting. Eur Respir Monogr 2005;31:1-14.
Karkhanis VS, Joshi JM. Spirometry in chronic obstructive lung disease (COPD). J Assoc Physicians India 2012;60 Suppl: 22-6.
Global Initiative for Asthma. GINA Global Strategy for Asthma Management and Prevention. Global Initiative for Asthma; 2015. Available from: http://www.ginaasthma.org. [Last accessed on 2018 Aug 09].
Quanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: The global lung function 2012 equations. Eur Respir J 2012;40:1324-43.
Al-Ashkar F, Mehra R, Mazzone PJ. Interpreting pulmonary function tests: Recognize the pattern, and the diagnosis will follow. Cleve Clin J Med 2003;70:866, 868, 871-3.
Keddissi JI, Elya MK, Farooq SU, Youness HA, Jones KR, Awab A, et al. Bronchial responsiveness in patients with restrictive spirometry. Biomed Res Int 2013;2013:498205.