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No asthma found in one third of Canadian adults With Physician-Diagnosed Asthma (2017-7-14)

In a multicenter cohort study that enrolled 701 randomly selected adults with physician-diagnosed asthma, current asthma was excluded in 33% of the 613 participants who completed the study.

The study set out to determine whether a diagnosis of current asthma could be ruled out and asthma medications safely stopped in randomly selected adults with physician-diagnosed asthma.

Dr Shawn Aaron from the University of Ottawa recruited 701 adults who had been diagnosed with asthma within the past five years from the community and brought them into their labs and ran extensive lung function tests on them to try to prove asthma.

If researchers could not show evidence of asthma, they then had the patients start to taper their asthma medications and kept following them and re-testing them with bronchial provocation tests to try to show asthma.

They also sent them to a pulmonologist to try to determine if there were other explanations for their symptoms apart from asthma.

Ultimately, 33 percent of the participants were found not to have active asthma, despite being completely off medications.

There are two reasons for this.

Firstly, some patients were misdiagnosed in the community Ė meaning they never had asthma to begin with.

Secondly, some had asthma, but it was inactive Ė meaning it was in remission.

A lot of other diseases can present with cough, shortness of breath, and wheeze.
For instance, serious diseases like congestive heart failure or pulmonary embolism can present with these symptoms, as well as much less serious diseases like allergic rhinitis or heartburn.

Asthma is not that difficult to diagnose, but doctors must order the proper tests to make the diagnosis correctly.
If they donít order the tests, they are more likely to get the diagnosis wrong, researchers found.

Ultimately misdiagnosis leads to treatment with the wrong medications that will have side effects without benefits.

This includes the cost of unnecessary asthma medications (an average of up to $1200 per year), the side effects of unnecessary medications (including oral thrush, easy bruising, osteoporosis, cataracts, glaucoma, tremor), insurance problems (being diagnosed with a chronic disease you donít have), anxiety, unnecessary lifestyle alterations, and a lost opportunity to diagnose the true cause of the patient's complaints.

Scientists found two percent of randomly selected patients had serious cardiac or pulmonary diseases that had been misdiagnosed as asthma.

Doctors should always order spirometry and appropriate lung function tests in anyone they suspect to have asthma and should also try to follow asthma treatment guidelines and reassess and taper asthma medications in patients who have been controlled for three months.

Patients should make sure they get breathing tests (spirometry) done before they accept a diagnosis of asthma if they are having trouble breathing.

Secondly, if they have been diagnosed with asthma and are well-controlled (in other words, they are not having shortness of breath or wheezing or coughing) they should ask their doctor to reassess the diagnosis with spirometry and then decide whether they can try tapering asthma medication out.

They should only do this with their doctor, not alone.

Of 701 participants 613 completed the study and could be conclusively evaluated for a diagnosis of current asthma.

Current asthma was ruled out in 203 of 613 study participants.

Twelve participants (2.0%) were found to have serious cardiorespiratory conditions that had been previously misdiagnosed as asthma in the community.

After an additional 12 months of follow-up, 181 participants continued to exhibit no clinical or laboratory evidence of asthma.

See also
The longer they live in Canada the more new immigrants allergy rates increase (2017-01-30)
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For more information
Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma
JAMA
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The University of Ottawa
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MDN