Bronchodilator Reversibility Testing Methods By Practicing Allergists

Rationale: Bronchodilator reversibility testing is used as a diagnostic test for asthma.  This study seeks to gather information about methods of administration, type and amount of bronchodilator dose used, wait time before repeat spirometry, and compliance with American Thoracic Society (ATS) guidelines of four Albuterol doses and a wait time of 10-15 minutes before repeat spirometry in allergists’ offices.

Methods: A questionnaire was approved and distributed by the American Academy of Allergy, Asthma, and Immunology (AAAAI) to all member allergists in North America and responses were collected over a three-week period. 

Results: Among 488 allergists who responded, 96.31% (n=470) used bronchodilator reversibility tests.  Albuterol, used by 93.90% (n=462) of allergists, was the most common medication. However, 4.07% (n=20) used non-recommended medications for reversibility testing. To administer medication, metered dose inhalers (MDI) with spacers were used by 59.34% (n=289) of allergists, and without spacers by 24.64% (n=120). Nebulizers were used by 58.52% (n=285).  Of those using MDIs, 23.21% (n=81) delivered four puffs, 58.74% (n=205) delivered two puffs and 10.32% (n=36) delivered 1, 3, 6 or 8 puffs of medication, respectively.  63.01% (n=307) of allergists waited 10-15 minutes before performing repeat spirometry, while 27.1% (n=132) waited >15 minutes and 9.86% (n=41) only waited <10 minutes.

Conclusions: The results indicate great variability in bronchodilator administration among allergists’, and that a significant percentage of allergists do not follow the ATS guidelines for bronchodilator reversibility testing methods.  Our data underscores the necessity of improved education on effective administration of bronchodilator tests in allergy practices.