Underdiagnosis and Overdiagnosis of Asthma

Abstract

Asthma is diagnosed on the basis of respiratory symptoms of wheeze, cough, chest tightness, and/or dyspnea together with physiologic evidence of variable expiratory airflow limitation. The prevalence of asthma varies widely around the world, ranging from 0.2% to 21.0% in adults and from 2.8% to 37.6% in 6- to 7-year-old children. Population-based studies in children, adults, and the elderly suggest that from 20% to 70% of people with asthma in the community remain undiagnosed and hence untreated. Underdiagnosis of asthma has been found to be associated with underreporting of respiratory symptoms by patients to physicians as well as poor socioeconomic status. On the opposite side of the spectrum, studies of patients with physician-diagnosed asthma suggest that 30-35% of adults and children diagnosed with asthma do not have current asthma, suggesting that asthma is also overdiagnosed in the community. Overdiagnosis of current asthma can occur because of physicians' failure to confirm variable airflow limitation at the time of diagnosis or when sustained clinical remission of disease goes unrecognized. In this review, we define under- and overdiagnosis and explore the prevalence and burden of under- and overdiagnosis of asthma both in patients and within healthcare systems. We further describe potential solutions to prevent under- and overdiagnosis of asthma.

Asthma in urban and rural pre‐ and primary schoolchildren according to the latest GINA definition

“…in accordance with what Aaron et al 7 reviewed for schoolchildren worldwide. Also, the present study provided evidence of under-diagnosed asthma in both settings (urban and rural), confirming that asthma diagnosis merely based on reported symptoms may be underestimating the real prevalence of this disease, as previously reported in the literature.…”

Cost-effectiveness of implementing objective diagnostic verification of asthma in the United States

“…10 We could not find any US-based study, but a recent systematic review on this topic reported that studies across different jurisdictions have consistently reported an overdiagnosis rate between 29% and 34%. 45 Our threshold analysis also indicated that the overdiagnosis rate in the US should be implausibly low for the diagnostic verification to not be cost-saving. We assumed that diagnostic verification would take place in the context of routine clinical practice, and as such, our results do not pertain to alternative schemes such as a systematic screening program.…”

Lung function in adults and future burden of obstructive lung diseases in a long-term follow-up

“…Different approaches to improve case finding in OLD have been investigated [7][8][9][10] . Especially among younger individuals, it can be difficult to predict the future risk of developing OLD, as disease progression is usually slow and can be influenced by more risk factors.…”

“…npj Primary Care Respiratory Medicine (2020)10 Published in partnership with Primary Care Respiratory Society UK 1234567890():,;…”