Examining factors related to diagnostic outcomes in shortness of breath patients with prescribed inhaler medications

Nugent, Jenese Meloney (2019) Examining factors related to diagnostic outcomes in shortness of breath patients with prescribed inhaler medications. Masters thesis, Memorial University of Newfoundland.

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Abstract

Over 10% of deaths are attributed to lung disease. Of these, asthma and chronic obstructive pulmonary diseases (COPD) are of significant global health concern. They are the two main obstructive airway diseases (OADs) associated with shortness of breath (SOB) symptoms and accounting for over 70% of patients presenting to the family physician (FPs) or requiring breathing relief. Underdiagnoses or over-diagnosis of asthma and COPD are common in SOB patients. Recent studies have reported these as widespread misdiagnoses in family practice. Many patients with SOB symptoms presenting to their FPs are often treated with inhaled medications and sometimes without proper diagnostic workup. Pulmonary function testing (PFT) along with physical examination and patient history are recommended by the international guidelines including the Canadian Thoracic Society guideline to objectively assist in the diagnosis, differentiation, and categorization of those with OADs for proper management. The primary objectives of this thesis are: 1) to examine care-gap in physician-diagnosed asthma and COPD in family practice (Study 1 in Chapter 3), and 2) to delineate factors associated with increased risk of spirometrically-derived diagnosis of asthma, COPD, and the overlap syndrome or ACOS in community patients with SOB symptoms and prescribed inhalers from FPs using pulmonary function testing (PFT) (Study #2 in Chapter 4). Understanding care gaps in clinical and individual patient’s factors which are associated with a proper diagnosis or misdiagnosis of asthma and COPD in SOB patients will help FPs improve the treatment and management of community patients with SOB symptoms.

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