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Bronchial Thermoplasty: A Novel Therapeutic Approach to Severe Asthma
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Patterns of bronchial challenge testing in Canada.

Rémi Thériault1, Amir Raz1,2,3,4

  • 1Faculty of Medicine, McGill University, Montréal, QC, Canada.

Canadian Journal of Respiratory Therapy : CJRT = Revue Canadienne De La Therapie Respiratoire : RCTR
|July 13, 2019
PubMed
Summary

Provincial variations in bronchial challenge testing (BCT) use for asthma diagnosis are linked to respirologist prevalence. Adhering to asthma guidelines for BCT is crucial to prevent misdiagnosis.

Keywords:
asthmabronchial challenge testingguidelinesmedical financial claimsmisdiagnosisrespirologists

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Area of Science:

  • Pulmonary Medicine
  • Health Services Research
  • Epidemiology

Background:

  • Bronchial challenge testing (BCT) is recommended for diagnosing asthma when spirometry is normal.
  • Inconsistent application of BCT guidelines contributes to asthma misdiagnosis.
  • Data on BCT utilization patterns in Canada are limited.

Purpose of the Study:

  • To investigate patterns of BCT utilization across Canadian provinces.
  • To explore correlations between BCT frequency and health system variables.
  • To identify factors influencing adherence to asthma diagnostic guidelines.

Main Methods:

  • Medical financial claims for BCT were obtained via the Access to Information Act from Canadian provinces.
  • Correlations were analyzed between BCT claim frequency and demographic data, including respirologist prevalence and health expenditures.
  • Statistical analyses were performed to assess relationships, controlling for population size.

Main Results:

  • Significant provincial disparities in BCT claims were observed, with Quebec showing high utilization and Alberta low utilization.
  • A moderate positive correlation was found between the number of respirologists per capita and BCT claims per capita (r=0.582).
  • Excluding specific Western provinces strengthened this correlation substantially (r=0.930), indicating a strong regional influence.

Conclusions:

  • Provincial variations in BCT use are evident and appear linked to the availability of respirologists.
  • Geographic factors, particularly a lower utilization in Western Canadian provinces, influence BCT administration.
  • Emphasizing adherence to Canadian asthma guidelines for BCT is essential for accurate diagnosis and to mitigate misdiagnosis risks.