The pendulum for asthma diagnosis may have swung too far to children being overdiagnosed with asthma, according to a paper published in the online journal Archives of Disease in Childhood.
Andrew Bush, MD, Professor of Pediatrics and Head of Section of Pediatrics at the Imperial College in London, and Louise Fleming, MD, Senior Clinical Lecturer in Respiratory Pediatrics at the National Heart and Lung Institute in the United Kingdom state in the article that proper diagnosis of asthma is important, because overdiagnosis can lead to potential problems. The paper argues that pediatric patients who do not need corticosteroids but are prescribed them are subject to potential adverse events, including growth suppression, adrenal failure and a greater risk of respiratory infection due to reduced immune cell activity in the airway.
To mitigate unnecessary overdiagnosis, Dr Bush and Dr Fleming suggest in their paper that first physicians must be completely familiar with normal respiratory symptoms that occur in pediatric patients.
Next, they recommend objective tests for asthma be performed, rather than relying on patient reported cough or wheeze to diagnose the disease. They argue for two guiding diagnosis principles in their article. The first is to obtain evidence of variable airflow obstruction in pediatric patients.
“The easiest is to measure peak flow at the point of care, and measure the acute response to a short-acting β-2 agonist (SABA),” the researchers noted. In addition, they recommend a two-week trial of home peak flow meters, which they said are underused.
In their article, the researchers urge physicians to focus treatment by matching inhaler dose to the degree of airway inflammation. They also argue that medication should not automatically be increased if the patient does not respond to treatment, in case the asthma diagnosis is incorrect. They also said that it should be kept in mind that children may outgrow the disease and not have an ongoing need for medication.
In an interview with Infectious Disease Advisor, Dr Bush said that he would offer the following advice for physicians: “If you think you are treating a child with a diagnosis of asthma, then make sure the diagnosis has been confirmed as far as possible with objective tests to avoid overdiagnosis. We must not trivialize the diagnosis. But make the diagnosis properly and treat appropriately,” he said.
1. Bush A, Fleming L. Is asthma overdiagnosed? Arch Dis Child doi:10.1136/archdischild-2015-309053. Published April 5, 2016. Accessed April 12, 2016.