Must family physicians use spirometry in managing asthma patients?: YES.

S tanbrook and Kaplan have previously suggested that " physicians who do not use spirometry for their asthma patients should not be managing asthma. " 1 They have put forth the notion that asthma management without spirometry testing would be considered failing to maintain an adequate standard of care, and that most primary care physicians " need to make testing available in their own offices. " 1 They developed this theme based on a study by Aaron et al, 2 whose results actually revealed that asthma diagnosis was confirmed in 16% and 72% of patients studied, by spirometry and methacholine challenge testing, respectively. Building a case for office spirometry based on these results seems counter-intuitive. 3 Further, Stanbrook and Kaplan did not cite a single reference in their article that described how widespread use of office spirometry in primary care might influence asthma outcomes in patients not previously diagnosed with asthma. 1 Spirometry can provide important information about lung function and health. Spirometry can be very helpful in excluding abnormalities in lung mechanics to discern the underlying cause of dyspnea. However, despite well-defined spirometric criteria for asthma diagnosis, 4 there are very few, if any, data from large, long-term trials that describe the benefits or limitations of routine spirometry in real-world asthma management. Therefore, I found the comments of Stanbrook and Kaplan disappointing because they were not supported by high-quality evidence. My concern is that, as a result of their recommendations , 1 physicians who do not use spirometry might be more inclined to refer asthma patients outside of their practices, a strategy that can hinder continuity of care 3 and exacerbate the problem of inadequate spirom-etry access in the community setting. Stanbrook and Kaplan's position represents a best-case scenario, supported by what some would call " wishful thinking, " which fails to consider some important clinical and practical considerations reported in the literature that are directly relevant to the primary care setting. For example, Lusuardi et al 5 did not find a significant advantage to adding office spirometry to conventional evaluation (history and physical examination) for identifying patients with asthma (P = .35), although statistical considerations (lack of adequate power) and poor enrolment might have resulted in a type II error. Stanbrook and Kaplan 1 suggest that barriers to office-based spirometry can be overcome, 6 but they do not discuss important limitations of such studies and reports in which …