It seems like a eureka moment — and it may, in fact, be just that: Your child, who has been nursing a cough and wheezing while exerting himself, is finally diagnosed — with asthma.
Historically, research finds this common chronic respiratory disease was missed in many children, and today experts say in certain populations in the U.S., like low-income families, asthma is still considered to be underdiagnosed. But based on more recent international research, some experts now question whether the pendulum has swung way too far in the other direction and argue that today, asthma is overdiagnosed in kids. “The published literature is clear that many have a diagnosis of asthma with no supporting evidence,” said Dr. Andrew Bush, a professor of pediatrics at Imperial College London who specializes in pediatric respiratory medicine, in an email. “We therefore need to up our game in using simple tests to confirm the diagnosis of asthma.”
[See: 7 Lifestyle Tips to Manage Your Asthma.]
Bush co-wrote an article with Dr. Louise Fleming, also of Imperial College London, for the international journal Archives of Disease in Childhood, which commissioned the analysis piece evaluating whether asthma is overdiagnosed. He noted recent research from the Netherlands that concluded overdiagnosis of childhood asthma is common; according to that research, more than half of the children studied who had been diagnosed with asthma likely did not have the condition. Bush and Fleming also cite an Australian paper in which more than half of 100 children who were studied had been given the diagnosis of asthma prior to the investigation; after concluding testing, the proportion thought to have asthma shrank to 5 percent, they wrote. Researchers say overdiagnosis of asthma can lead to unnecessary treatment and expose kids to medication side effects.
One confounding factor in getting it right is that there’s no gold standard for diagnosing asthma, says Dr. Elizabeth Matsui, a professor of pediatrics at the Johns Hopkins University School of Medicine, who chairs the American Academy of Pediatric’s Section on Allergy and Immunology. “There’s no blood test that tells you, this is asthma,” adds Dr. Erwin Gelfand, chair of pediatrics at National Jewish Health in Denver.
Instead, the diagnosis is often made based upon a child’s symptoms, without additional testing done. However, experts point out that symptoms alone may not tell the whole story. “All that wheezes is not asthma,” Gelfand says. “There are many things that can cause a child to apparently have an asthma-like attack, with wheezing, but it’s not really asthma in the usual sense.” Instead, he says, the wheezing might be caused by another disease, such as croup or bronchiolitis, a congenital issue causing airway inflammation or even a small foreign body — say, a pea — stuck in a child’s wind pipe. Nor is a chronic cough a sure sign of asthma, either, doctors say.
Practitioners add that, at present, asthma testing also leaves something to be desired. “The tests in asthma are sometimes not sensitive enough or sometimes not specific enough,” Matsui explains. That can lead to both missed diagnoses as well as overdiagnosis. In addition, children under 5 or 6 can’t be tested using lung function tests, like spirometry, Gelfand says, “because they can’t blow properly — they can’t use the equipment properly.”
[See: 8 Surprising Facts About Asthma and Seasonal Allergies.]
Sometimes children are started on medication like an inhaled corticosteroid as a means of diagnosis, to see if their symptoms respond and determine whether they have asthma. The doctor may then have the child stop taking the medications to see if symptoms return. However, though treatment is generally considered safe, Bush and Fleming write that side effects associated with asthma medications range from kidney failure and growth suppression to an increased risk of respiratory infections, and that children shouldn’t be left on therapeutic trials of treatment indefinitely. Children should not take asthma medications for prolonged periods if the medication doesn’t help address the symptoms they’re experiencing, Matsui echoes.
An evaluation of a child suspected to have asthma should include looking at a child’s family history — parents with asthma are much more likely to have children with asthma — and other factors that could be contributing, such as allergy triggers ranging from pets to dust mites. For parents of children whose symptoms don’t respond to asthma medication, experts recommend taking the child in for a follow-up evaluation and tests, as necessary, to confirm the original diagnosis. (Routine follow-up care for a child with asthma should also include discussing medication dosage with the doctor to ensure it’s kept as low as possible to be effective, while limiting side effects.) If parents have questions about a child’s asthma diagnosis, they should see a specialist, such as a pediatric allergist or pediatric pulmonologist, who could more definitively define whether asthma is present, Gelfand says. “It doesn’t mean the pediatrician or family practice is wrong, it’s just the next step in an evaluation.” Furthermore, Bush and Fleming advise an additional safeguard is to consider the diagnosis of asthma as dynamic, since many children outgrow their symptoms, and many doctors frequently get it wrong. “No matter who has made the diagnosis, always consider whether it was actually correct in the first place, or whether it is still relevant,” they write.
Experts stress that just as parents should insist on a proper diagnosis, they shouldn’t cease a child’s treatment simply because they believe a diagnosis of asthma may be wrong. “Don’t stop the inhalers! Because if your child does have asthma, this could be catastrophic,” Bush says. “Asthma kills children in the USA as well as the UK.” More than 3,600 people of all ages died from asthma in 2013, according to the latest data available from the Centers for Disease Control and Prevention.
Poorly managed or undiagnosed asthma can also have significant impact on a child’s lung function and quality of life, Gelfand says. For an infant or young child, it could result in poor sleeping, less energy, poor feeding and chronic coughing, so parents should be alert to possible symptoms of asthma in their children: “Are they running around like all the other kids? Do they stop and hunch over because they’re trying to catch their breath? Are they waking up at night coughing?” he says. “Nighttime coughing is probably the most important symptom of asthma.”
[See: Top Reasons Children End Up in the Hospital.]
Ultimately, parents’ due diligence could make all the difference. Given, as Matsui notes, there’s some degree of overdiagnosis and underdiagnosis, experts say parents should discuss any concerns with their child’s physician and follow-up, as needed, to ensure proper diagnosis — whether the child has asthma or not.
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Was the Doctor Right About Your Child’s Asthma Diagnosis? originally appeared on usnews.com
