Half a million children ‘wrongly diagnosed with asthma’

    26 February 2016

    Research published in the British Journal of General Practice suggests that children are regularly being misdiagnosed with asthma.

    The condition affects over a million children in Britain, but the new research suggests that this figure could be inaccurate; if so, thousands of children could be needlessly taking medication with adverse side effects, which can include throat infections, nausea and muscle cramps.

    NICE (the National Institute for Health and Care Excellence) is to update its guidelines so that clinical tests are carried out before a diagnosis is made. They say that doctors are making diagnoses based on patients’ reported history of breathing problems, rather than clinical tests.

    Researchers from the University Medical Centre in Utrecht looked at the medical records of 656 children diagnosed with asthma, and found that 53 per cent had no clinical signs of the condition.

    The researchers say that this is because doctors are failing to properly assess patients, and that the appropriate lung function tests aren’t being conducted as a matter of routine. They found that asthma could be confirmed in only 16.1 per cent of the children they tested, and ‘suspected’ in 23.2 per cent.

    Dr Ingrid Looijmans-van den Akker said: ‘Over-diagnosis of asthma was found in more than half of the children, leading to unnecessary treatment, disease burden, and impact on their quality of life.

    ‘Previous studies have indicated that asthma is over-diagnosed in children. However, the scale has not been quantified.

    ‘Only in a few children was the diagnosis of asthma confirmed using lung function tests, despite this being recommended in international guidelines.

    ‘Over-diagnosis gives rise to over-prescription and incorrect use of medication, and to anxiety in parents and children.’

    Expert verdict
    The fact that only 16 per cent of children were diagnosed with asthma based on adherence to international guidelines, with 54 per cent receiving an over-diagnosis, is very concerning. This is surprising as, while formal lung spirometry (lung function tests) is only available at hospitals, peak flow spirometry (the instrument patients blow into, found in GP clinics worldwide) considered the ‘poor man’s spirometer’, is freely available.

    A weakness of the study is that it did not address any of the complications of over-diagnosis. There was also no comparison of the quality of life of patients correctly verses incorrectly diagnosed.

    The reasons for the overdiagnosis were unclear. Was it difficult or expensive to refer patients for spirometry or was spirometry unavailable?

    This paper demonstrates the need for any diagnosis of asthma in children to be made by following established guidelines.
    Research score: 3/5