Doctors over-diagnosing asthma in children, experts warn


Inhalers are being dished out like "fashion accessories", leading doctors have said as they warned that medics 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.

Dr Samantha Walker, director of research and policy at the charity Asthma UK, said: "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 under-diagnosed, 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."