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Is childhood asthma being misdiagnosed?

Tagged In:  NHS

New research from the Netherlands has reignited the debate about diagnostic methods.

Earlier this year a claim that over one million adults in the UK may have been wrongly diagnosed with asthma sparked a fierce debate amongst health professionals, with an open letter to doctors' journal Pulse from a number of senior respiratory specialists describing the claim as 'unhelpful and misleading'. Now a new peer-reviewed study by researchers in the Netherlands seems to show significant misdiagnosis of asthma in Dutch children and it has been suggested that this may also be happening in the UK.

The study, which was published in the British Journal of General Practice, found that 53.5% of children aged 6 to 17 years diagnosed with asthma probably didn't have the condition. If the percentage of misdiagnosis were found to be similar in the UK, it would mean around half a million children are being told they have asthma when they haven't. However, as the NHS Choices website points out, there is no evidence to support the assertion that a similar level of misdiagnosis is happening here.

That being said, it's widely acknowledged that there's no room for complacency. The National Institute for Health and Care Excellence (NICE) is aware that there may be an issue with current practice and is reviewing its guidance to improve asthma diagnosis. "Accurate diagnosis of asthma has been a significant problem, which means that people may be wrongly diagnosed or cases might be missed in others”, commented Professor Mark Baker, NICE Director of Clinical Practice on the publication of the draft guidance in January this year. "Our aim with this guidance is to give clarity and set out the most clinical and cost effective ways to diagnose and monitor asthma based on the best available evidence."

The root problem is that diagnosis of asthma in children is notoriously difficult. "There isn't a single, quick, easy test," says Asthma UK, the country's leading asthma charity. Historically, the diagnosis has been based principally on a thorough medical history taken by an experienced clinician. NICE's new draft guideline suggests that spirometry (a lung function test used in the Dutch research) should be used as the first-line investigation for everyone over the age of five. In children under that age, a lung function test is not possible so diagnosis must be exclusively based on symptoms.

Because asthma symptoms can come and go, as part of the diagnosis process, many patients are asked by their GP or asthma nurse to keep a symptom diary. This enables the doctor or nurse to assess if the patient is experiencing regular symptoms which are unrelated to colds or viruses or which are triggered by other factors, such as exercise, pets or damp air.

As we discussed in our recent blog post about over-prescribing of drugs, with demand for its services continuing to increase, the NHS needs to find new, innovative models of care and improved efficiency to secure its future. With 5.4 million people in the UK currently receiving treatment for asthma, but many of them perhaps not actually suffering from the condition, more accurate diagnosis has to be an important goal.

The new NICE guidance is expected to be published in full later this year or early in 2017.

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