A Nose for Diagnosing Asthma.

Abstract

Asthma is a staple diagnosis for primary care providers across the world, with its workup being outside the laboratory and squarely in the clinic. Until now, perhaps: Investigators at the Icahn School of Medicine at Mount Sinai in New York, led by Dr. Supinda Bunyavanich, are exploring the use of an RNA test of nasal brushings to diagnose asthma. Bunyavanich, Associate Director of the Jaffe Food Allergy Institute and Associate Professor at Mount Sinai, did not have to go far for inspiration. She runs a pediatric allergy and immunology clinic where every week she confronts the realities of treating asthma. “I see patients who struggle with our current tools. Trying to get objective data usually depends on spirometry, which can be difficult. In many primary care settings, you don't have spirometry on the spot,” she explains. And spirometry has its challenges. It requires trained staff and demands a precise performance by patients to arrive at adequate measurements. “Most patients just find spirometry difficult to do,” Bunyavanich concludes. Dr. Raj Kapoor, a pulmonologist and specialist in critical care and sleep medicine, supports this view. “The old adage, ‘Not all that wheezes is asthma,’ attributed to physician Chevalier Jackson, has never been more relevant than today,” he says, citing reports that at least 30% of physicians' asthma diagnoses are incorrect. “The overdiagnosis of allergic or nonallergic asthma can lead to weeks, months, or even years of unnecessary albuterol and controller drug treatment,” says Kapoor. Since her fellowship training, Bunyavanich has been thinking about the relationship between the biology of the upper and lower airways. Dr. Supinda Bunyavanich The field has struggled with …