Specialists Say Childhood Asthma Is Overdiagnosed

Theresa Bebbington

April 07, 2016

In an article published in the journal Archives of Disease in Childhood, two respiratory specialists claim that doctors are overdiagnosing asthma in children, with inhalers being prescribed needlessly.

According to Asthma UK, 1.1 million children living in the UK have asthma -that's 1 in 11 children.

There is no question that in the past asthma had been underdiagnosed. However, the specialists Professor Andrew Bush and Dr Louise Fleming, of Imperial College and Royal Brompton and Harefield NHS Foundation Trust, argue that the pendulum has now swung too far in the opposite direction.

High Costs and Side Effects

The authors claim there is evidence that children in the UK are being overdiagnosed with asthma, especially a form known as cough-variant asthma. They say that this not only matters because of the cost of inhalers, but also because children are being exposed to the medications' side effects.

They point out that properly used inhaled corticosteroids (ICS) can dramatically improve a child's quality of life, reduce the risk of asthma attacks and even prevent death. However, they also highlight that these medicines have side effects, including growth suppression in children and an increased risk of respiratory infections.

The authors also express concern that incorrect diagnoses and "failures in basic management" have resulted in childhood death.

Fashion Accessory

Professor Bush and Dr Fleming write: "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."

The authors point out that having a detailed knowledge of normal respiratory systems in healthy children is key in diagnosing asthma correctly, yet the word wheeze - the hallmark symptom of asthma - is used imprecisely by both parents and healthcare professionals.

The two respiratory specialists outline various approaches to aid correct diagnosis, including two basic principles: there should be evidence of variable airflow obstruction; and if therapeutic trials of treatment are given, they should be focused and children should not be kept on an unproven treatment.

They have also expressed a need for healthcare professionals to remember that many children outgrow asthma symptoms, and remind them that treatment shouldn't simply be stepped up if a child fails to respond, because there's a chance the diagnosis might not be right in the first place.

Challenge of Diagnosis

In response to the article, Dr Samantha Walker, director of research and policy at Asthma UK, says in a statement: "This illustrates the challenges that GPs face every day because there currently isn't one definitive way of easily diagnosing asthma. It's astonishing in the 21st century that there isn't a test your child can take to tell if they definitely have asthma.

"Asthma isn't one condition but many, with different causes and triggered by different things at different ages. Asthma symptoms also change throughout someone's life or even week by week and day by day. This complexity means that it is both over and underdiagnosed, in children and in adults, so people don't get the care they need to manage their asthma effectively. As a result, a child is admitted to hospital every 20 minutes because of an asthma attack and asthma attacks still kill the equivalent of a classroom of children every year in the UK.

"We urgently need more investment in asthma research to get to a definitive test to ensure people get the right diagnosis."


Archives of Disease in Childhood: 'Is asthma overdiagnosed?'

Asthma UK