Addressing the misdiagnosis of asthma in adults: where does it go wrong?

Abstract

Asthma is diagnosed based on patients' respiratory symptoms of wheeze, cough, chest tightness and/or dyspnea together with physiologic evidence of variable and reversible expiratory airflow limitation. A high prevalence of overdiagnosis, underdiagnosis and misdiagnosis of adult asthma has been reported in the literature. Areas covered: Misdiagnosis of asthma in adults can occur in the community due to physicians' failure to confirm airflow limitation using spirometry, the relatively poor sensitivity of spirometry to absolutely rule in asthma, the complexity of multiple asthma phenotypes and endotypes, and the inherent day to day variability of asthma symptoms and airflow limitation. Consequences of asthma misdiagnosis to the patient and to the healthcare system include increased medication costs, increased potential side effects related to unnecessary use of medications and lost opportunities to diagnose the true cause of patients' respiratory symptoms. Expert commentary: Here we provide a review of the problem of misdiagnosis of adult asthma and suggestions for how to decrease the risk of misdiagnosis.

Non‐malignant respiratory disease among workers in the rubber manufacturing industry: A systematic review and meta‐analysis

“…Although spirometry is commonly used to identify work‐related NMRD, baseline lung function testing that includes spirometry combined with other non‐traditional testing methods such as impulse oscillometry or FeNO might improve NMRD testing sensitivity. Spirometry, as a single lung function test, has a poor sensitivity for work‐related asthma . Identifying work‐related asthma in a cross‐sectional study includes establishing a relationship between symptoms and work through a medical questionnaire and lung function testing .…”

Asthma: A Loss of Post-natal Homeostatic Control of Airways Smooth Muscle With Regression Toward a Pre-natal State

“…Unfortunately it does. The failure to define the condition leads to fashions, driven by "opinion leaders" keen to promote their latest "asthma paradigm, " which in turn contributes to the huge burden of over and under diagnosis experienced by patients (3)(4)(5)(21)(22)(23). Failure to apply clear diagnostic criteria means that findings of epidemiological studies are probably of little value and at worst can be very misleading (24).…”

“…It is widely accepted that bronchodilator responsiveness as demonstrated by an increase in FEV1 of 12% or greater 4 , 5 Main report: p19, will identify pediatric asthmatic subjects. The diagnosis can also be supported by a "positive" response to one of the numerous forms of challenge testing.…”

“…Depressingly, over-and under-diagnosis of asthma remains common (3)(4)(5)(21)(22)(23). The lack of focus on objectively documenting the presence of the key component of asthma is one of the principle reasons for over diagnosis.…”

“…This inability to define the condition is associated with a depressingly high on-going prevalence of mis-diagnosis (both over and under) (3)(4)(5), morbidity and mortality in most countries. The introduction of inhaled corticosteroids (ICS) in the early 1970s (6,7) was the one great step forward in the intervening 140 years; yet despite having safe and effective therapy, levels of morbidity and mortality remain unacceptably high, particularly in countries such as the U.K. and Australia 1 (8).…”