Reassessment of Asthma Diagnoses Highly Recommended for Adult Patients with Asthma

A multicenter study assessing adult asthma patients in ten Canadian cities proposed that reassessment of asthma diagnoses in adult patients is necessary to ensure proper treatment and to avoid overmedication.

Although asthma remission is more common in patients with childhood asthma, new research suggested that periodic reassessment in patients with adult asthma for spontaneous remission might help safely wean those patients become weaned off of asthma medications.

According to Shawn D. Aaron, MD, (photo) Senior Scientist at the Clinical Epidemiology Program at the Ottawa Hospital Research Institute, "contemporary guidelines suggest stepping down treatment once good asthma control has been achieved and maintained for 3 months," and regular testing of patients could help guide healthcare providers in identifying when treatment may be decreased, or slowly ceased.

The research team from ten university hospitals throughout Canada, reported that "many physicians choose to diagnose and treat patients empirically for asthma" without proper airflow testing, relying instead on symptoms to determine the presence of asthma in patients.

However, according to Aaron, diagnosis of asthma should not rely on presence of asthma-like symptoms (wheezing, coughing, chest tightness, dyspnea), which could be evidence of other respiratory issues, particularly in adult populations. The different phenotypes of asthma often present differently in patients, and can be misdiagnosed if proper guidelines for diagnosis outlined by the American Thoracic Society, including spirometry testing for airflow obstruction and bronchial challenge testing, are not completed.

The twelve-week study recruited 701 patients with physician-diagnosed asthma evaluate contemporary diagnostic practices and determine whether there was a need for diagnostic reassessment in adult patients with asthma. Only 613 patients completed the study, which included spirometry, assessment of each patient's medical history and use of asthma-controlling medications, and completion of the European Community Respiratory Health Survey and Asthma Quality of Life Questionnaire.

Patients also received a confirmation of asthma or were asked to step down medications and return for retesting. Researchers were able to rule out asthma in 33% of subjects originally diagnosed with asthma by physicians — these patients worked with assigned pulmonologists for assistance and re-diagnosis.

Study participants for whom asthma was ruled out ended their asthma medications and took part in a 6- and 12-month reassessment to confirm that there was no worsening or recurrence of asthma or asthma symptoms. Aaron and colleagues also contacted the original diagnosing physician for each participant to confirm whether or not the original diagnosis had been based on symptoms alone, or through diagnostic testing; they discovered only 11.8% of those patients had been originally diagnosed using objective testing.

Of the 613 patients who completed the study, 231 showed no evidence of airflow obstruction, bronchial hyper responsiveness, or worsening of symptoms after being tapered off all asthma medications. The study’s pulmonologists provided individual consultations to determine asthma diagnoses or even provide alternative diagnoses for nearly a total of 203 study participants.

The most common alternative diagnoses reported were for relatively benign conditions; many patients were asymptomatic." Also, 12 of the patients originally misdiagnosed with asthma were found to have serious cardiorespiratory conditions.

According to the team, their results suggested more emphasis on appropriate initial diagnostic work up including objective testing for initial asthma diagnoses and recurrent assessment of diagnosis for changes in patient status and lung function is necessary to manage patient care.

The study, “Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma,”was published in the January 2017 issue of the Journal of the American Medical Association (JAMA).

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