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Over half of asthma patients may be ‘over-diagnosed’

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Asthma is wildly over-diagnosed in primary care, suggests a study by Dutch researchers.

In their study of 652 children who had been diagnosed with asthma or were treated as having the condition, only 105 had the diagnosis confirmed by spirometry.

“There is, however, no single test that can definitively diagnose asthma”

Maureen Baker

But overall they suggested that at least half of the children previously diagnosed with asthma were “unlikely” to have the respiratory condition, following subsequent testing.

The researchers said that previous studies have indicated that asthma in children is probably over-diagnosed, but theirs was the first to assess the extent to which it occurred.

They assessed children aged six to 18 years who had a prior diagnosis of asthma or were being treated for the condition at primary healthcare centres in Utrecht.

Overall, in 53.5% of the children, the signs and symptoms made asthma unlikely and thus they were most likely over-diagnosed, they said in the British Journal of General Practice.

“It’s important parents work in partnership with their GP or nurse to build a complete picture of their child’s asthma”

Dan Murphy

In 16% the diagnosis confirmed with spirometry, whereas in 23% the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests.

The remaining 7.2% were probably correctly classified as not having asthma, they added.

The researchers found the main reasons for classifying asthma without children undergoing further lung function tests were dyspnoea, cough, and wheezing.

They stated: “Over-diagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life.

“However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests,” they said.

“To avoid overtreatment, medicalisation, and anxiety in parents, a more structured diagnostic strategy including lung function testing in children under suspicion of having asthma is warranted,” they added.

Responding to the study, Dr Maureen Baker, chair of the Royal College of GPs, said, “Asthma is an extremely distressing condition affecting one in 11 children.

Maureen Baker

182Maureen Baker

Maureen Baker

“There is, however, no single test that can definitively diagnose asthma, and this can make it difficult to do in primary care, particularly when some common symptoms are similar to those of other illnesses,” she said.

“Some useful diagnostic tests are already available in primary care in the UK, but we need increased investment so that we can broaden access to this equipment and undergo the training necessary,” she added.

Dan Murphy, director of external affairs at the charity Asthma UK, said: “This is a small study that took place in a country that has a very different healthcare system to the UK.”

But he added: “Asthma has many complex causes which is why it is very difficult to get a definitive diagnosis. It is also a highly variable condition that can change throughout someone’s life or even week by week.

“It’s important parents work in partnership with their GP or nurse to build a complete picture of their child’s asthma to tailor their treatment,” he said, adding that annual reviews were “the bedrock of asthma care”.

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