No Coughing Matter


Jaxon Hernandes, MD, a hospitalist with Apogee Physicians at Clara Maass Medical Center in Belleville, N.J., believes he and his colleagues are positioned perfectly to help properly diagnose asthma, a timely opinion given new Canadian research suggesting the bronchial condition routinely is over-diagnosed.

The study in the Canadian Medical Association Journal (2008;179(11):1121-1131) found up to 30% of adults diagnosed with asthma had no evidence of the condition. It included 496 people from eight Canadian cities who reported a diagnosis of asthma from their physician. The researchers' goal was to determine whether obese people were more likely to be misdiagnosed with asthma, but researchers found the issue was just as prevalent in people of normal weight.

Henderson notes hospitalists rarely make initial diagnoses when a patient is first encountered in the hospital, but once they are admitted, a hospitalist can order peak-flow-rate and spirometric tests. Clinical guidelines recommend using a spirometer to objectively measure long volume and airway flow.

"The hospitalist is in a position where he can get the pulmonologist to do what he needs to do," Dr. Hernandes says. "He can force a diagnosis being made."

Dr. Hernandes adds hospitalists have an onus to order the tests because doctors "may be under-diagnosing the primary issue with a patient or over-diagnosing and psychologically scarring them."

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