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doi:10.1378/chest.07-0159
(Chest. 2007; 131:1615)
© 2007 American College of Chest Physicians
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There Are No Excuses for Not Performing Spirometry in Acute Asthmatics in the Emergency Department Setting

Gustavo J. Rodrigo, MD

Hospital Central de las Fuerzas Armadas, Montevideo, Uruguay

Correspondence to: Gustavo J. Rodrigo, MD, Departamento de Emergencia, Hospital Central de las Fuerzas Armadas. Av. 8 de Octubre 3020, Montevideo 11600, Uruguay; e-mail: gurodrig{at}adinet.com.uy

To the Editor:

I read with great interest the article in CHEST by Silverman and colleagues1 (January 2007). I think that it is a very important article because is the first attempt to assess the performance of spirometry in an acute care setting. Thus, it is well established that the severity of airflow obstruction cannot be accurately judged by means of symptoms and physical examination.234 On presentation, after the initial treatment, and at subsequent frequent intervals, the measurement of lung function as FEV1 or peak expiratory flow (PEF) provides an objective evaluation of airway obstruction and constitutes an integral part of the assessment of disease severity (static assessment) and the response to therapy (dynamic assessment) in any patient > 5 years of age. In spite of this evidence, acute asthma patients are assessed inappropriately. One prospective study5 reported the measurement of PEF in only 30% of patients. Reasons for the lack of more intensive use of PEF or FEV1 in the emergency department (ED) setting are not clear, although factors that may impact include the idea that patients are incapable to perform spirometry because they are acutely ill and severely obstructed. However, Silverman and colleagues1 demonstrate conclusively that most adult patients seen for severe asthma exacerbations in an ED can successfully perform criteria-specific acceptable and reproducible spirometry maneuvers. All patients were able to blow for at least 1 s in at least one effort for all time points. Finally, the study also supports the concept that inexperienced investigators can be quickly trained to meet minimal performance standards. In summary, there are no excuses for not perform spirometry in acute asthmatics in the ED setting.

Footnotes

Dr. Rodrigo has received fees for speaking for Boehringer Ingelheim, GlaxoSmithKline, and AstraZeneca, and honoraria as consultant from CYDEX Inc. and Discovery Laboratories.

References

  1. Silverman, RA, Flaster, E, Enright, PL, et al (2007) FEV1 performance among patients with acute asthma: results from a multicenter clinical trial. Chest 131,164-171[Abstract/Free Full Text]
  2. NHLBI/WHO workshop report: global strategy for asthma management and prevention. 2002 National Institutes of Health. Bethesda, MD: publication 02–3659
  3. Global Initiative for Asthma. Global strategy for asthma management and prevention, revised 2006. Available at: www: ginasthma.com. Accessed January 15, 2007
  4. Rodrigo, GJ, Rodrigo, C, Hall, JB Acute asthma in adults: a review. Chest 2004;125,1081-1102[Abstract/Free Full Text]
  5. Borderías, CL, Zabaleta, MM, Riesco, MJA, et al Coste y manejo de una crisis asmática en el ámbito hospitalario de nuestro medio (estudio COAX en servicios hospitalarios). Arch Bronconeumol 2005;41,313-321[CrossRef][ISI][Medline]




This Article
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