Asthma Diagnoses Might Require Reevaluation in Some Adults

Patient using a occuasthma inhaler at Carelife Medical

Asthma Diagnoses Might Require Reevaluation in Some Adults

Asthma Diagnoses Might Require Reevaluation in Some Adults

Asthma was ruled out in about a third of patients with previously diagnosed adult-onset asthma.

National Asthma Education and Prevention Program (NAEPP) guidelines emphasize confirming an initial asthma diagnosis with reversible airflow obstruction on spirometry and following a patient to see if his or her medications can be stepped down (J Allerg Clin Immunol 2007; 120:S94). In this Canadian cohort study, researchers evaluated 613 patients who had received diagnoses of adult-onset asthma during the previous 5 years to determine whether they Jonathan Ericsson limited jersey truly had asthma and whether their medications could be discontinued safely. Participants underwent serial diagnostic evaluations based on symptoms, spirometry, and methacholine challenge. If results were normal, patients were weaned off their medications. Those who had no reversible airflow obstruction or airway hyper-reactivity after all medications were stopped were deemed not to have asthma.

Asthma was excluded in 33% of the patients, less than half of whom had spirometry performed as part of their initial diagnoses. The most common alternative diagnoses generally were benign, but 12 patients had serious cardiopulmonary conditions that required intervention


I see many patients who’ve been using expensive inhalers for years without knowing if they truly have asthma. A third of patients in this study either never had asthma or had asthma that later went into remission. This reminds us that all patients should undergo pre- and post-bronchodilator spirometry before being given diagnoses of asthma, and, per NAEPP guidelines, to “consider a step down in therapy once asthma is well controlled for at least 3 months.” For patients with normal spirometry at baseline, clinicians should consider a methacholine challenge before labeling them as asthmatic.


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