Experts warn that doctors are over-diagnosing asthma in children

The diagnosis of asthma has been “trivialised”, two leading respiratory doctors said.

Over-diagnosing the condition matters, not only because of the cost of inhalers but also because of their side effects, which are more likely to occur in patients who are prescribed an inappropriate dose, they said.

Writing in the Archives of Disease in Childhood, the authors highlight a previous study in which half of 100 children with chronic cough received an asthma diagnosis, but once the coughs were thoroughly investigated, the number actually thought to have asthma dwindled to 5%.

Professor Andrew Bush, from the Royal Brompton and Harefield NHS Foundation Trust, and Dr Louise Fleming of Imperial College London, said the National Review of Asthma Deaths highlights the need for correct diagnosis.

They continue: “It is an intensely depressing document which shows that no lessons have been learnt over the last 15 years, and children still die because of failures in basic management.

“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.”

They add: “Is there any other chronic disease in the world in which children are committed to potentially hazardous, long-term therapy without every effort being made objectively to document the diagnosis?”

The authors say children of school age should be properly assessed to see if they have variable airflow obstruction before receiving a diagnosis.

And if doctors trial different treatments on youngsters these must be “focused” and “children should not be left on an unproven treatment ad infinitum”.

The authors outline various approaches to aid correct diagnosis, including the need to remember that many children outgrow asthma symptoms, and that treatment should not simply be stepped up if the child fails to respond, because there is a chance the diagnosis might not be right in the first place.

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