Correct Diagnosis Of Asthma Research Articles

Is asthma over-diagnosed in Cyprus? A clinical study at the outpatient’s primary care level

Background: Although asthma is a common disease accurate diagnosis is missing and it has been reported that often it is over or under-diagnosed. Aim: To investigate if a physician’s diagnosis of asthma in Cyprus is correct by using a structured algorithm at the outpatient primary care level. Subjects and Methods: Sixty adults with a self-reported physician diagnosis of asthma, mean age of 47,8 years (29 males and 31 females) were included in the study. Medical history and physical examination, pre-post bronchodilation spirometry and methacholine bronchial challenge test was used to confirm or rule out the diagnosis as well as a three months follow-up. In addition, the cost of treatment was estimated. Results: Sixteen subjects (27%) had a positive pre-post bronchodilation spirometric test and were considered asthmatics. In 9 out of the 44 remaining subjects a positive Methacholine provocation test confirmed the diagnosis of asthma. The rest of the subjects (n = 35) went into a 3 months observational period during which only 2 showed asthmatic symptoms and were considered asthmatics by a second methacholine test that confirmed the diagnosis. Therefore, a correct asthma diagnosis was established in only 27(45%) of subjects. The annual average cost of medication for asthma confirmed the group was 313 euro/patient (171-454, 95% CI) and the average 2-year unnecessary (asthma ruled-out group) cost of treatment was approximately 297 euro/patient. (179-415, 95% CI). Conclusions: Physician-diagnosed asthma overestimates the actual prevalence of disease in adults in Cyprus since it was shown that more than half of the participants did not have Asthma. These individuals consume unneeded medications at a significant cost. Thus, the correct diagnosis of Asthma should be made by using more specific tests starting at the primary care level.

Nieuwe aanbevelingen voor de diagnose en monitoring van astma bij volwassenen in de eerste lijn

New recommendations for the diagnosis and monitoring of asthma in adults in primary care Asthma is a major health problem and is common in adults. The timely and correct diagnosis of asthma in adults is important to initiate the correct (drug) treatment. Asthma can usually be diagnosed in primary care, but sometimes additional tests are needed in secondary care. This article summarizes the recently published recommendations for diagnosis and monitoring of asthma. The guideline is intended for primary care providers, in particular for general practitioners, but also for pharmacists. Collaboration with secondary care is essential for the implementation of these recommendations.

Misdiagnosis of asthma in schoolchildren.

A correct diagnosis of asthma is the cornerstone of asthma management. Few pediatric studies have examined the accuracy of physician-diagnosed asthma. We determined the accuracy of parent reported physician-diagnosed asthma in children sampled from a community cohort. Nested case-control study that recruited 203 children, aged 9-12, from a community-based sample. Three groups were recruited: asthma cases had a parental report of physician-diagnosed asthma, symptomatic controls had respiratory symptoms without a diagnosis of asthma, and asymptomatic controls had no respiratory symptoms. All participants were assessed and assigned a clinical diagnosis by one of three study physicians, and then completed spirometry, methacholine challenge, and allergy skin testing. The reference standard of asthma required a study physician's clinical diagnosis of asthma and either reversible bronchoconstriction or a positive methacholine challenge. Diagnostic accuracy, sensitivity and specificity were calculated for parent-reported asthma diagnosis compared to the reference standard. One hundred two asthma cases, 52 controls with respiratory symptoms but no asthma diagnosis, and 49 asymptomatic controls were assessed. Physician agreement for the diagnosis of asthma was moderate (kappa 0.46-0.81). Compared to the reference standard, 45% of asthma cases were overdiagnosed and 10% of symptomatic controls were underdiagnosed. Parental report of physician-diagnosed asthma had 75% sensitivity and 92% specificity for correctly identifying asthma. There is significant misclassification of childhood asthma when the diagnosis relies solely on a clinical history. This study highlights the importance of objective testing to confirm the diagnosis of asthma. Pediatr Pulmonol. 2017;52:293-302. © 2016 Wiley Periodicals, Inc.

Severe Asthma: Anti-IgE or Anti-IL-5?

Asthma is a common disease affecting more than 300 million people worldwide [1]. According to the recent ERS/ATS consensus severe asthma is defined as asthma that requires treatment with high dose Inhaled corticosteroids (ICS) plus one more controller (and/or oral corticosteroids) in order to be controlled or remains uncontrolled despite the above treatment or becomes uncontrolled with the reduction of high dose ICS or oral corticosteroids [2]. It is a prerequisite that the correct diagnosis of asthma has been confirmed and comorbidities have been identified and treated properly [2]. It is also extremely important to check inhaler technique and ensure good adherence to treatment. Current GINA document suggests that a referral to a specialist with expertise in the management of severe asthma is strongly encouraged for patients not controlled with treatment step 3 [1].

Recognizing Asthma Mimics and Asthma Complications

Asthma is a chronic inflammatory disorder of the airways characterized by airflow obstruction, bronchial hyperreactivity, and underlying inflammation. Two common reasons asthmatics fail standard therapy are incorrect diagnosis and failure to recognize underlying contributing factors. A correct diagnosis of asthma is of great importance to military practitioners since misdiagnosis or uncontrolled asthma affects an individual's operational readiness or determines whether one can receive a medical waiver to enlist in military service. This article presents four cases of patients with dyspnea that have conditions which mimic asthma or complicate asthma management: vocal cord dysfunction misdiagnosed as asthma, respiratory bronchiolitis interstitial lung disease mistaken as asthma, difficult-to-control asthma because of bronchiectasis and allergic bronchopulmonary aspergillosis, and difficult and fatal asthma. Asthma is contrasted to other respiratory disorders, and an outlined approach to asthma diagnosis and management is presented using the Global Initiative for Asthma guidelines.

Difficult Asthma

The correct diagnosis of asthma is usually easily made and most patients with asthma respond to therapy. Approximately 5% of patients with asthma, however, have disease that is difficult to control despite taking maximal doses of inhaled medications. Patients with therapy-resistant or difficult-to-control asthma require a rigorous and systematic approach to their diagnosis and treatment. The first step is evaluation and testing directed at determining that asthma is the correct diagnosis. Many diseases mimic asthma and these alternate diagnoses should be considered. The second step is to identify and eliminate triggers that worsen asthma. Cigarette smoking, occupational exposures, and allergic rhinitis contribute to worsening disease. Most patients with "difficult asthma" require treatment with high-dose inhaled corticosteroids and long-acting inhaled beta(2)-agonists. Despite maximal inhaled therapy, these patients will require either frequent bursts or chronic daily therapy with oral corticosteroids. These patients may have "resistant" inflammation with a persistent inflammatory state. Numerous studies also suggest that compliance with asthma therapy is poor. Combination therapy with inhaled corticosteroids and long-acting beta(2)-agonist in a single inhaler may improve patient compliance. In selected patients, additional therapy with leukotriene modifiers or anti-IgE antibody can result in improved asthma control and may allow tapering of corticosteroids. Use of methotrexate is not justified based on current data. Emerging evidence suggests that different phenotypes of difficult or therapy-resistant asthma exist. Recognition of these subgroups allows tailored therapy and prevents overmedication in an attempt to normalize lung function in patients with irreversible airflow obstruction.

Towards improving the accuracy of diagnosing asthma in early childhood

Objectives: Early and correct diagnosis of asthma in wheezing children is essential for early treatment and prevention of under-or over-treatment. The aim was to study whether combining frequency and age of onset of wheezing illness with respiratory and atopic morbidity at age 0–6 years and sociodemographic parameters for asthma might be helpful for the general practitioner to diagnose asthma early and accurately.Methods: Birth cohort, mean follow-up 20 years (SD 4.8) in general practice. The outcome, adolescent asthma, was analysed in relation to wheezing and non-wheezing respiratory and personal and familial atopic morbidity. All diagnoses were from the Continuous Morbidity Registration of the Department of General Practice of the University of Nijmegen, the Netherlands.Results: 1586 (64%) of the children could be followed. Adolescent asthma occurred in 6.4%. There were indications for under-and over-diagnosis of asthma at age 0–6 years. Non-recurrent wheezing (only one episode) and recurrent wheezing (2 episodes) in the first three years of life, and recurrent wheezing at age 4–6 increased the risk with odds ratios (95% confidence interval) of 3.3 (1.9–5.6), 4.7 (2.8–8.2) and 15.4 (7.1–33.7), respectively. The risk additionally increased independently with a family history for asthma, (2.0 [1.1–3.6]), atopic dermatitis (1.7 [1.1–2.7]) and sinusitis (2.9 [1.3–6.4]) and decreased for 2nd born children (0.38 [0.19–0.74]) and those with a low social-economic status (0.61 [0.39–0.94]).Conclusion: Easily available history and clinical data may facilitate the early diagnosis of asthma in children with wheezing illness.

Response: Educational self-help approaches in childhood asthma

Asthma self-management programs are most effective if they succeed in increasing individual control over the symptoms, thereby reducing the unpredictability and variability of asthma. Before any attempt at self-care as defined by Levin et al. l can be implemented, certain barriers need to be resolved. As workers in this field have come to realize, the intrinsic interand intrasubject variability of the asthmatic syndrome creates certain limitations, demands, and different emphases when developing self-management strategies, as noted in several studies. ‘-I7 Most of the comments that follow apply to moderate-to-severe asthma since mild episodic asthma is rarely a problem. First of all, the limitations deal with the process of seeking the correct diagnosis; this often requires the self-care initiative discussed by Levin et al.’ and is often stifled by the medical care maze some individuals are made to face. One often receives calls from confused parents and patients regarding the diagnosis, the treatment, and which specialist to see-the allergist or the pulmonologist. The diagnosis of asthma remains a problem for many whose disease is misdiagnosed and mismanaged, thus delaying the initiation of appropriate care. lx The next point that may create confusion for the person with asthma is the variety of treatment modalities presently available. lgPzl This, coupled with the individuality of the asthmatic syndrome, adds to the complexity of the situation in the layperson’s view, a situation somewhat similar to the diabetic’s situation.22 Once the correct diagnosis of asthma has been made and the person linked with a competent physician, the appropriate individualized care is initiated and Bandura’s self-efficacy theory23 can be implemented. Special emphases should deal with a disease histor-