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Is childhood asthma overdiagnosed?


Doctors are overdiagnosing asthma in children argue two secondary care respiratory paediatricians  in an opinion piece  published online in the Archives of Disease in Childhood

Professor Andrew Bush and Dr Louise Fleming of Imperial College and Royal Brompton & Harefield NHS Foundation Trust say that in the past asthma was undoubtedly underdiagnosed, but the evidence now is that the pendulum has swung too far in the opposite direction. This matters, not only because of the cost of inhalers, but also because of their side effects, which are more likely to occur in patients who receive asthma medication inappropriately. Key to diagnosing asthma correctly is a detailed knowledge of normal respiratory symptoms in healthy children. All too often, the hallmark symptom of asthma—wheeze—is used imprecisely by both parents and healthcare professionals. More objective evidence, such as simple breathing tests, is required before a diagnosis is made, they suggest.

Dr Duncan Keeley, PCRS-UK Policy Lead, comments: ‘While we know that asthma may be over diagnosed, this paper does not present any new evidence to show that this is the case.

‘The key to improving standards of asthma diagnosis is for repeated careful clinical assessment in primary care - where most asthma diagnoses are made. As the article suggests, careful clinical assessment supported by peak flow monitoring, careful trials of introducing and withdrawing treatment and regular review of the diagnosis, with readiness to refer for specialist assessment when the diagnosis is in doubt are the key elements.’

PCRS-UK recommends that if anxious parents, who have read press reports about this article, contact you:

  • Review the patient record and check the basis for the child’s diagnosis
  • If the basis for the diagnosis is unclear, be prepared to review it
  • Review the diagnosis in line with the BTS/SIGN asthma guideline

Action points:

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