Asthma is being overdiagnosed, doctors warn

Inhalers are frequently dispensed for no good reason, leading medics claim

Doctors are overdiagnosing asthma, with inhalers frequently dispensed for no good reason, according to two leading respiratory doctors.

Such is the level of overdiagnosis that inhalers have "almost become a fashion accessory," they write in the journal Archives of Disease in Childhood.

In the past asthma was undoubtedly underdiagnosed, but the evidence now is that the pendulum has swung too far in the opposite direction, say Prof Andrew Bush and Dr Louise Fleming of Imperial College and Royal Brompton & Harefield NHS Foundation Trust.

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 are prescribed an inappropriate dose.

“Inhaled corticosteroids, when properly used, dramatically improve quality of life and reduce the risk of asthma attacks and mortality,” they write.

But there are potential side effects associated with their use, they point out.

These include growth suppression and the dampening down of immune cell activity in the airways and the subsequent heightened risk of respiratory infections.

Prescribed dose

“There is also evidence that systemic absorption of [inhaled corticosteroids] depends not just on the prescribed dose, but is greater if the dose is inappropriately high for the degree of airway inflammation,” the doctors caution.

In Ireland, the Asthma Society says the doctors' views "may cause concern" for parents but it is vital they do not stop children taking medication on this basis, without first discussing it with their doctor.

This is no evidence that the condition is being overdiagnosed in Ireland or inhalers given out without good reason, according to a spokeswoman.

Asthma has many complex causes and it can be difficult to get a definitive diagnosis, she said.

“This means treatment also needs to change over time.”

Fashion accessory

Key to diagnosing asthma correctly is a detailed knowledge of normal respiratory symptoms in healthy children, Prof Bush and Dr Fleming say.

“We propose that one contributing factor is that the diagnosis of asthma has been trivialised and inhalers dispensed for no good reason, and have become almost a fashion accessory.”

“The result is, the fact that asthma is a killing disease if not correctly managed, is overlooked,” they say.

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.

“Is there any other chronic disease in the world in which children are committed to potentially hazardous, long-term therapy without every effort being made objectively to document the diagnosis?” they ask.

They outline various approaches to aid correct diagnosis, including the need to remember that many children outgrow asthma symptoms, and that treatment should not simply be stepped up if the child fails to respond, because there is a chance the diagnosis might not be right in the first place.

In Ireland one person dies from asthma every week.