One-Third of Adults With Recent Asthma Diagnosis Do Not Have Asthma
A third of randomly selected adults diagnosed with asthma in the previous 5 years did not have the condition upon reexamination, according to a new JAMA study. Most of those asthma-free adults, however, were taking asthma medication—more than a third, daily.
“It's impossible to say how many of these patients were originally misdiagnosed with asthma, and how many have asthma that is no longer active,” said lead author Shawn Aaron, MD, senior scientist and respirologist at The Ottawa Hospital and professor at the University of Ottawa. “What we do know is that they were all able to stop taking medication that they didn't need — medication that is expensive and can have side effects.”
The study focused on 613 adults from 10 Canadian cities recently diagnosed with asthma by a physician. Detailed breathing tests and consultation with a lung specialist revealed that 33% of participants did not have active asthma. More than 90% of those adults were able to stop their asthma medication and remain safely off the drugs for 1 year.
Of the 530 patients with accessible medical records, researchers found diagnosing physicians had not ordered airflow tests required by medical guidelines 49% of the time.
“Doctors wouldn't diagnose diabetes without checking blood sugar levels, or a broken bone without ordering an x-ray,” said Dr. Aaron. “But for some reason many doctors are not ordering the spirometry tests that can definitely diagnose asthma.”
Upon re-examination, most of the patients without active asthma were rediagnosed with allergies or heartburn. Two percent were rediagnosed with serious conditions such as heart disease or pulmonary hypertension. For 28%, researchers found nothing wrong.
“It wasn't a surprise to most patients when we told them they didn't have asthma,” said Dr. Aaron. “Some knew all along that their puffer wasn't working, while others were concerned that they might have something more serious. Thankfully, the majority of the conditions were mild and easily treated.”
An editorial in the issue highlighted 2 takeaways from the findings: physiological testing is essential to avoid misdiagnosis and unnecessary treatment, and patients diagnosed with adult-onset asthma may not have the condition indefinitely.
“The study by Aaron and colleagues is an important reminder that in addition to reviewing asthma symptoms and treatment, trying to understand if the diagnosis of asthma is still appropriate is an important part of clinical care,” Helen M. Hollingsworth, MD, and George T. O’Connor, MD, MS, both of the pulmonary center at the Boston University School of Medicine, observed.—Jolynn Tumolo
References
Hollingsworth HM, O’Connor GT. Asthma—here today, gone tomorrow? JAMA. 2017;317:262-263.
