Inclusion of Asthma in Otolaryngologic Clinical Practice

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April 2009

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Figure. Evidence is increasingly pointing to the need to treat both allergies and asthma for optimal patient outcomes.

Although the vast majority of patients presenting with symptoms of asthma continue to be initially seen by primary care physicians, otolaryngologists are increasingly seeing patients with symptoms of asthma that either have not been correctly identified or are not being adequately treated. As such, incorporating asthma into otolaryngologic practice seems a natural evolution of a specialty that focuses on regional diseases between, what is common parlance among otolaryngologists as, the dura and pleura, according to Harold C. Pillsbury III, MD, Chair of the Department of Otolaryngology-Head and Neck Surgery at the University of North Carolina School of Medicine in Chapel Hill. Already, he said, including asthma into an otolaryngologic practice is quite widespread among 40% to 50% of otolaryngologists within the American Academy of Otolaryngic Allergy (AAOA) who already treat allergies; however, this is less common among members of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS).

Efforts to increase awareness of the need to adequately diagnose and, where appropriate, treat asthma are under way within the academies. Similar to the previous adoption of allergies as a condition to include within the realm of otolaryngologic practice, the expansion into asthma reflects the evolutionary character of a specialty that continues to adapt to the changing demands and needs of the times.

Why the focus on asthma now? One reason, according to Dr. Haydon, may simply be the increased incidence of asthma owing to more indoor and outdoor pollutants, which is placing a high demand on the health care field. The prevalence of asthma is on the rise, and there are a number of patients with asthma who are not being adequately treated, he said. We, as otolaryngologists, are going to encounter these patients, and it is appropriate, where there is a need and interest, to try to assist other physicians taking care of these patients.

For Dr. Pillsbury, the need for otolaryngologists to address asthma in their patients with allergies comes from a growing body of evidence that shows substantial improvement in these patients when treated with new asthma medications such as montelukast (Singulair) and pulmonary inhalers.

And perhaps most important, diagnosis of asthma is now easier as pulmonary function tests have become more accessible. We’re doing pulmonary function tests on our patients, which used to be a big deal, but now there is a little computerized version of a pulmonary function test that you can do in the office, he said.