Building a diagnostic picture of asthma in primary care: Development of a novel ‘jigsaw puzzle’ approach

Introduction: Asthma remains under- and over-diagnosed globally.1 Primary care practitioners (PCPs) identified an educational need for simple tools to diagnose asthma in the absence of a single objective test.2 New teaching and learning tools are required. Aims: To describe the process of defining the format and content of teaching/learning tools to facilitate and improve the quality of asthma diagnosis by PCPs without an asthma interest or specific training using a jigsaw puzzle metaphor. Methods: A half-day “jigsaw“ workshop of primary care academics and clinicians in low, middle and high income countries with an asthma diagnosis interest was convened. Four working groups in two rounds negotiated and prioritised jigsaw pieces describing: reason for presentation, symptoms, predisposing factors and tests/investigations most relevant when building a clinical picture of asthma. In the third round a single comprehensive jigsaw puzzle was formed through debate about relative importance of jigsaw pieces over time (https://youtu.be/jguPHc8XHDE). This process can be repeated and contextualised at national level. Content: Building the puzzle begins with establishing the reason/s for presentation in primary care followed by an exploration of the respiratory symptoms. A personal and family history is important and continuity of care is crucial as more than one encounter is often needed to build the diagnostic puzzle. Objective tests should be considered where available. Other tests such as blood eosinophil levels or FeNO may be considered. Conclusions: This project identified a new teaching and learning strategy, the asthma jigsaw puzzle, to create a context-specific development process and a tool enabling PCPs to visualise the clinical picture and decide on the likelihood of an asthma diagnosis before taking action. References: 1. Aaron SD, et al. CMAJ 2008;179:1121-31. 2. Abdel-Aal A, et al. npjPrim Care Respir Med 2022;32:6.