Nav: Home

Asthma not found in high percentage of adults who were previously diagnosed

January 17, 2017

Among adults with a previous physician diagnosis of asthma, a current diagnosis could not be established in about one-third who were not using daily asthma medications or had medications weaned, according to a study appearing in the January 17 issue of JAMA. The researchers speculate that the failure to confirm the diagnosis could be because of spontaneous remission or misdiagnosis.

Diagnosis of asthma in the community can be difficult. Various types have been identified, all of which potentially have different triggers and clinical presentations. Asthma can be episodic or can follow a relapsing and remitting course, which further complicates attempts to arrive at a diagnosis based on a single patient-physician encounter. Although asthma is a chronic disease, the expected rate of spontaneous remissions of adult asthma and the stability of diagnosis are unknown.

Shawn D. Aaron, M.D., of the Ottawa Hospital Research Institute, University of Ottawa, Canada, and colleagues conducted a study that included 701 adults who reported a history of physician-diagnosed asthma established within the past five years. All participants were assessed with home peak flow and symptom monitoring, spirometry (measures lung function), and bronchial challenge tests, and those participants using daily asthma medications had their medications gradually tapered off over four study visits. Participants in whom a diagnosis of current asthma was ultimately ruled out were followed up clinically with repeated bronchial challenge tests over one year.

Of 701 participants, 613 completed the study and could be conclusively evaluated for a diagnosis of current asthma, which was ruled out in 203 of 613 study participants (33 percent). Twelve participants (2 percent) were found to have serious cardiorespiratory conditions that had been previously misdiagnosed as asthma in the community. After an additional 12 months of follow-up, 181 participants (30 percent) continued to exhibit no clinical or laboratory evidence of asthma. Participants in whom current asthma was ruled out, compared with those in whom it was confirmed, were less likely to have undergone testing for airflow limitation in the community at the time of initial diagnosis (44 percent vs 56 percent, respectively). More than 90 percent of participants in whom asthma was ruled out had asthma medications safely stopped for an additional one-year period.

"Two phenomena may account for failure to ultimately confirm current asthma in 33.1 percent of the study cohort: (1) spontaneous remission of previously active asthma; and (2) misdiagnosis of asthma in the community. At least 24 of 203 participants (11.8 percent) in whom current asthma was ruled out had undergone pulmonary function tests in the community that had been previously diagnostic of asthma. These participants presumably experienced spontaneous remission of their asthma at some time between their initial community diagnosis and entry into the study," the authors write.

"This study also suggests that misdiagnosis of asthma may occasionally occur in the community. In 2.0 percent of study participants, a serious untreated cardiorespiratory condition was identified that may have been previously misdiagnosed as asthma. In addition, the study demonstrated that failure to consistently use objective testing at the time of initial diagnosis of asthma was associated with failure to confirm current asthma. These results suggest that whenever possible, physicians should order objective tests, such as prebronchodilator and postbronchodilator spirometry, serial peak flow measurements, or bronchial challenge tests, to confirm asthma at the time of initial diagnosis."
-end-
(doi:10.1001/jama.2016.19627; the study is available pre-embargo at the For the Media website)

Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.

Related material: The editorial, "Asthma - Here Today, Gone Tomorrow?" by Helen M. Hollingsworth, M.D., and George T. O'Connor, M.D., M.S., of the Boston University School of Medicine, also is available at the For The Media website.

To place an electronic embedded link to this study in your story This link will be live at the embargo time: http://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.2016.19627

The JAMA Network Journals

Related Asthma Articles:

Physics vs. asthma
A research team from the MIPT Center for Molecular Mechanisms of Aging and Age-Related Diseases has collaborated with colleagues from the U.S., Canada, France, and Germany to determine the spatial structure of the CysLT1 receptor.
New knowledge on the development of asthma
Researchers at Karolinska Institutet in Sweden have studied which genes are expressed in overactive immune cells in mice with asthma-like inflammation of the airways.
Eating fish may help prevent asthma
A scientist from James Cook University in Australia says an innovative study has revealed new evidence that eating fish can help prevent asthma.
Academic performance of urban children with asthma worse than peers without asthma
A new study published in Annals of Allergy, Asthma and Immunology shows urban children with poorly controlled asthma, particularly those who are ethnic minorities, also suffer academically.
Asthma Controller Step Down Yardstick -- treatment guidance for when asthma improves
The focus for asthma treatment is often stepping up treatment, but clinicians need to know how to step down therapy when symptoms improve.
Asthma management tools improve asthma control and reduce hospital visits
A set of comprehensive asthma management tools helps decrease asthma-related visits to the emergency department, urgent care or hospital and improves patients' asthma control.
Asthma linked to infertility but not among women taking regular asthma preventers
Women with asthma who only use short-acting asthma relievers take longer to become pregnant than other women, according to research published in the European Respiratory Journal.
What are the best ways to diagnose and manage asthma?
A team of experts from The University of Texas Medical Branch at Galveston examined the current information available from many different sources on diagnosing and managing mild to moderate asthma in adults and summarized them.
Insomnia prevalent in patients with asthma
A team of researchers from the University of Pittsburgh has found that insomnia is highly prevalent in adults with asthma and is also associated with worse asthma control, depression and anxiety symptoms and other quality of life and health issues.
Test used to diagnose asthma may not be accurate
A new study urges caution in the use of the mannitol challenge test for asthma in non-clinical settings.
More Asthma News and Asthma Current Events

Top Science Podcasts

We have hand picked the top science podcasts of 2019.
Now Playing: TED Radio Hour

Accessing Better Health
Essential health care is a right, not a privilege ... or is it? This hour, TED speakers explore how we can give everyone access to a healthier way of life, despite who you are or where you live. Guests include physician Raj Panjabi, former NYC health commissioner Mary Bassett, researcher Michael Hendryx, and neuroscientist Rachel Wurzman.
Now Playing: Science for the People

#544 Prosperity Without Growth
The societies we live in are organised around growth, objects, and driving forward a constantly expanding economy as benchmarks of success and prosperity. But this growing consumption at all costs is at odds with our understanding of what our planet can support. How do we lower the environmental impact of economic activity? How do we redefine success and prosperity separate from GDP, which politicians and governments have focused on for decades? We speak with ecological economist Tim Jackson, Professor of Sustainable Development at the University of Surrey, Director of the Centre for the Understanding of Sustainable Propserity, and author of...
Now Playing: Radiolab

An Announcement from Radiolab