Rate of asthma diagnosis questioned
Wednesday April 6th, 2016
Asthma is routinely overdiagnosed, two senior respiratory doctors say today.
Professor
Andrew Bush and Dr Louise Fleming of Imperial College and Royal Brompton
& Harefield NHS Foundation Trust, UK, make their comments in the Archives
of Disease in Childhood.
The authors refer to a recent Australian paper in which more than 100 children with chronic cough were investigated intensively, including with bronchoscopy, half were given a diagnosis of asthma prior to investigation. By the end of testing, the number still thought to have asthma had shrunk to 5%.
"Although cough-variant asthma exists, it is overdiagnosed," they write, "isolated cough in the community is rarely, if ever, due to asthma." They call for a greater awareness of the range of symptoms caused by ordinary upper respiratory infections in the normal child.
They say that asthma inhalers may bring side effects including adrenal failure and growth suppression, "with increasingly worrying evidence (mainly in adults) that they cause mucosal immunosuppression and an increased risk of respiratory infections."
The latest National Review of Asthma Deaths, led by the Royal College of Physicians, highlights another reason why the diagnosis of asthma must be more accurate. "It is an intensely depressing document," Bush and Fleming write, "which shows that no lessons have been learnt over the last 15 years, and children still die because of failures in basic management."
They propose that one contributing factor is that the diagnosis of asthma "has been trivialised and inhalers dispensed for no good reason, and have become almost a fashion accessory".
Professor Bush said today: "It is important not to over-diagnose asthma, and thus prescribe unnecessary inhalers, in part because this trivialises the diagnosis of what can be a killing disease.
"As with every condition requiring long term treatment, every effort should be made to make an objective diagnosis of asthma. Properly used, asthma inhalers are life-saving if you have asthma, but if you do not, there is a risk of side-effects, and resources are wasted."
Commenting on the article, Dr Maureen Baker of the Royal College of GPs said: "Parents and children should be reassured that in the majority of asthma cases, they are managed well with the right treatment and appropriate monitoring."
She added: “Some useful diagnostic tests are already available in primary care in the UK, but we need increased investment so that we can broaden GP access to this equipment and undergo the training necessary to use it in the best interests of our patients.”
Bush, A. and Fleming, L. Is asthma overdiagnosed? Archives of Disease in Childhood 6 April 2016; doi 10.1136/archdischild-2015-309053 [abstract]
Tags: Allergies & Asthma | Child Health | Respiratory | UK News
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