In my work, I get to educate a diverse group of people living with asthma and their caregivers. One of the first questions I ask is, “Have you had lung function testing?” Unfortunately, the answer, often, is “no.”
That leads me to ask a few follow-up questions, such as “How did your doctor diagnose you? What type of exam did you get?” The answer is usually the same; “My doctor asked about my symptoms and listened to my lungs.” The end.
Lung function tests: An official way to diagnose asthma
To be clear, when diagnosing asthma a doctor should absolutely ask about symptoms and listen to your lungs. However, these two things alone will not paint a full picture of your disease. There is a national set of guidelines (known as EPR-3 from the National Heart, Lung and Blood Institute) that all medical providers should follow. These guidelines state the only way to officially diagnose asthma is with lung function testing.
For those of us who have survived lung function testing, we know it’s hard. In fact, it’s so hard when we blow into the spirometer for six seconds it’s called a maneuver. It’s especially hard when we are having a flare up, so I totally understand why we shy away from this testing. However, lung function testing is best practice, and should be the standard of care followed by every doctor who treats a patient with asthma.
Why? I’ll explain . . .
If you are having symptoms that could be caused by diabetes, your doctor will order a blood test to check your glucose level and A1C. Based on these numbers, the doctor will make an informed decision based on a national set of guidelines – either you do or do not have diabetes – and if you do those numbers will show how severe your diabetes is, and how well it is controlled. Once the level of severity and control is established, your doctor can prescribe the correct amount of insulin for you to take. The same with high blood pressure, a doctor would never diagnose someone with hypertension without checking their blood pressure and following a set of national guidelines. Before you can take medication to lower high cholesterol, a blood test is given to gauge your HDL/LDL levels per national guidelines.
So, if it’s automatic for doctors to conduct testing to diagnose chronic diseases such as diabetes, high blood pressure and high cholesterol, why is it not automatic for the diagnosing of asthma? Without knowing your lung function testing numbers, doctors are not only making an educated guess that you have asthma, but also guessing on its severity and level of control. Doctors are prescribing medication without really knowing which medication (and how much to take) may be best. And they are not following best practices as outlined in the national guidelines.
Of course, lung function testing like spirometry is not as easy as giving blood for a glucose test or spending two minutes having your blood pressure tested. But, it’s just as important. My advice for every person with asthma is to advocate for yourself and insist on getting lung function testing. Your doctor may offer this in-house, or may refer you to a specialty asthma clinic. Either way, testing will let you know the severity of your asthma and how well it is controlled.
Ask your doctor to follow national guidelines and best practices for managing your asthma, just like he/she does with other chronic conditions.
Have you had lung function testing such as spirometry or the methacholine challenge? Please share your stories with us!
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