Pediatric asthma is regularly overdiagnosed

Inhalers are often inappropriately prescribed to children assumed to have asthma without proper diagnostic testing.
Inhalers are often inappropriately prescribed to children assumed to have asthma without proper diagnostic testing.

Clinicians regularly overdiagnose asthma in children, leading to an increase in harmful side effects, according to an article published in the Archives of Disease in Childhood.

Professor Andrew Bush, of the Department of Pediatric Respiratory Medicine at the Royal Brompton Hospital in London, and Louise Fleming, MD, of the National Heart and Lung Institute in London, noted that although asthma was “undoubtedly underdiagnosed” in the past, “the evidence now is that the pendulum has swung too far in the opposite direction.

Inhaled corticosteroids, when properly used, dramatically improve quality of life and reduce the risk of asthma attacks and mortality,” the researchers continued. However, they said that potential side effects are more likely to occur in patients who are inappropriately prescribed inhalers, including growth suppression and the dampening of immune cell activity in airways, leading to a heightened risk of respiratory infections.

Professor Bush and Dr Fleming noted that one way to prevent inappropriate diagnosis is to work to correctly diagnose asthma in the first place; clinicians should have a detailed knowledge of normal respiratory systems in healthy children, and simple breathing tests should be required before a diagnosis can be made.

“We must seek evidence of variable airflow obstruction, at least in school-age children, before contemplating asthma diagnosis,” wrote the authors. They emphasized that fixed and variable airflow obstructions, nature of airway inflammation, and presence of chronic infection should be considered when dealing with childhood airway diseases.

Reference

  1. Bush A, Fleming L. Is asthma overdiagnosed? Arch Dis Child. 2016; doi: 10.1136/archdischild-2015-309053
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