TORONTO - Almost a third of adult Canadians diagnosed with asthma and
taking medications to treat their wheezing, coughing and shortness of breath may
not actually have the allergic respiratory condition at all, researchers say.
In a study of about 500 adults who had previously been told they have asthma,
airway-function and other tests showed that about 30 per cent did not in fact
have the disease, suggesting that asthma may be significantly overdiagnosed in
Canada.
"What we think is happening ... is that if patients come to a physician
complaining of shortness of breath or cough or wheeze, oftentimes the physician
will assume that the diagnosis is asthma, and based on the patient's history and
complaints prescribe medicines to treat asthma," lead investigator Dr. Shawn
Aaron said from Ottawa.
"And what they won't do is order the appropriate diagnostic test to confirm
asthma."
Aaron, head of respiratory medicine at Ottawa Hospital and the University of
Ottawa, said a doctor's suspicion that a patient has asthma should be followed
up by confirmatory tests, including spirometry.
A spirometer measures a person's lung volume and airway flow, which can flag
whether airways are likely narrowed by inflammation, as is the case with asthma.
When the researchers tested the 496 study subjects with a diagnosis of asthma,
they found 150 did not test positive for the condition, Aaron said. "And when we
stopped their medicine and assessed them, we weren't able to find asthma."
Yet these patients had been taking asthma medications - typically inhaled
steroids, also known as puffers - for an average of 15 years, say the
researchers, whose paper is published in this week's issue of the Canadian
Medical Association Journal.
"This is a serious issue because asthma medications are expensive and they can
have side-effects," Aaron said. "Also, an inappropriate diagnosis of asthma may
obscure the true cause of a patient's symptoms."
While inhaled corticosteroids are generally considered safe drugs, higher rates
of osteoporosis, glaucoma and cataracts have been seen in patients after
long-term use.
But he cautioned that patients shouldn't forgo asthma drugs in the belief they
may have been misdiagnosed, because the airway-clogging condition can be
life-threatening. Instead, they should ask their doctor for the confirmatory
tests.
"I don't want people to assume that they've been overdiagnosed and stop their
medicine. That would be very dangerous."
An estimated three million Canadians have asthma, about 12 per cent of them
children, says the Asthma Society of Canada on its website. Prevalence of the
disease - which kills about 20 children and 500 adults across the country each
year - has been on the rise over the last 20 years around the world.
Commenting on the study, Toronto respirologist Dr. Ken Chapman agreed that
asthma is overdiagnosed and spirometry tests are not performed as often as they
should be.
"They're saying things near and dear to my heart and near and dear to the hearts
of all practising lung doctors," Chapman, director of the Asthma Airway Centre
at University Health Network, said of the study authors.
"We're endlessly frustrated that doctors think that they can manage lung disease
without measuring lung function."
Chapman said several respiratory conditions can mimic the symptoms of asthma,
including chronic obstructive pulmonary disease, or emphysema, which can affect
current and former smokers.
"It's time that doctors dragged themselves out of the Stone Age when it comes to
lung disease," he said. "If you can't measure lung function, you can't identify
abnormal lung function and treat it appropriately."
In an accompanying editorial, deputy CMAJ scientific editor Dr. Matthew
Stanbrook and Dr. Alan Kaplan of the Family Physician Airways Group of Canada
argue that diagnosing asthma without objective tests is unacceptable medical
practice.
"A physician who attempted to manage hypertension without measuring blood
pressure or to manage (high cholesterol) without measuring serum cholesterol
levels would not be considered to be maintaining an adequate standard of care,"
they write. "Treating asthma without having performed at least spirometry is no
different."
Any physician who treats asthma should regularly refer patients to a lung
function laboratory, have staff to perform spirometry or perform the test
themselves, say Stanbrook and Kaplan, adding that governments need to license
more of these labs, so that proper testing is available across the country.
The study was conducted in eight locations across the country.