Half a million children with asthma in UK may not actually have condition
New research suggests that doctors are regulary misdiagnosing children and Nice is due to change guidelines so that GP carry out clinical tests
Half a million children who have been diagnosed with asthma may not actually have the condition, new research suggests.
Doctors are failing to properly assess youngsters in surgeries or carry out appropriate lung function tests which would give a definitive finding, it is claimed.
More than one million children have been diagnosed with asthma in Britain, but the new study suggests more than half may not have the chronic lung condition and could be at risk from the side effects of their medication.
Last year the NHS watchdog warned that around one third of ‘asthmatic’ adults showed no clinical signs and had probably been misdiagnosed.
In a new study published in the British Journal of General Practice, researchers from the University Medical Centre in Utrecht, The Netherlands, looked at the medical records of 656 children diagnosed with asthma at four centres. 53 per cent were found to have no clinical signs of the condition.
The Netherlands consistently tops polls of the best healthcare in the Europe, so the problem could be even worse for British children.
Dr Ingrid Looijmans-van den Akker, said: “Over-diagnosis of asthma was found in more than half of the children, leading to unnecessary treatment, disease burden, and impact on their quality of life.
“Previous studies have indicated that asthma is over-diagnosed in children. However, the scale of has not been quantified.
“Only in a few children was the diagnosis of asthma confirmed using lung function tests, despite this being recommended in international guidelines.
“Over-diagnosis gives rise to over-prescription and incorrect use of medication, and to anxiety in parents and children.”
The National Institute of Clinical Excellence (Nice) said that too often doctors were basing diagnosis on case history of breathing problems, wheezing and coughs rather than any clinical tests.
The watchdog is so concerned it is currently drawing up new guidelines advising doctors to use more clinical tests to back up their judgement and avoid the danger of wrongly labelling someone as asthmatic. Nice said it would be using the new report to inform its future guidance, which is expected to be published later this year.
Professor Mark Baker, director of clinical practice at Nice, said: “Nice is currently developing a guideline to provide advice for primary, secondary and community care healthcare professionals on the most suitable tests for accurately diagnosing asthma and how to help people monitor and control their symptoms.
“As part of this work, NICE is inviting GP practices to take part in a project to check the feasibility of some diagnostic tests that Nice proposes to recommend.
“Relevant research like the BJGP paper is helpful in informing the NICE asthma guideline development.”
Over-treatment is a concern because some of the drugs used to manage asthma can have significant side-effects including muscle cramps, throat infections, tremors, vomiting and nausea. Children with asthma often avoid exercise, which can lead to weight problems.
The best test for asthma is spirometry – which uses a machine to measure how much and how fast a person breathes out. However the Dutch new research found that a spirometer had only been used in around 16 per cent of the cases checked. Most children were diagnosed simply because they had trouble breathing or had a persistent cough.
Dr Maureen Baker, Chair of the Royal College of GPs, said, "There is no single test that can definitively diagnose asthma, and this can make it difficult to do in primary care, particularly when some common symptoms are similar to those of other illnesses.
“Some useful diagnostic tests are already available in primary care in the UK, but we need increased investment so that we can broaden GP access to this equipment and undergo the training necessary to use it in the best interests of our patients.”
Asthma is a chronic inflammatory respiratory disease. It can affect people of any age, but often starts in childhood. It is characterised by attacks of breathlessness and wheezing, with the severity and frequency of attacks varying from person to person.
The attacks are associated with variable airflow obstruction and inflammation within the lungs, which if left untreated can be life threatening, however with the appropriate treatment can be reversible
Asthma prevalence is thought to have plateaued since the late 1990s, although the UK still has some of the highest rates in Europe and on average three people a day die from asthma.
Dan Murphy, Director of External Affairs at Asthma UK, said it was often difficult to diagnose athma.
“Asthma has many complex causes which is why it is very difficult to get a definitive diagnosis," he said.
“It is also a highly variable condition that can change throughout someone’s life or even week by week, meaning treatment also needs to change over time.
“For example, children whose asthma is triggered by pollen may have no symptoms during an annual asthma review in winter and present completely differently in the summer.
"It’s important parents of children with asthma work in partnership with their GP or nurse to build a complete picture of their child’s asthma to tailor their treatment.
“It is vital that no parent of a child with an asthma diagnosis stops them taking their medication on the basis of this information, without discussions with their doctor.”
There were 1,167 deaths from asthma in the UK in 2011, 18 of these were children aged 14 and under.
An estimated 75 per cent of hospital admissions for asthma are avoidable and as many as 90 per cent of the deaths from asthma are preventable.
The NHS spends around £1 billion a year treating and caring for the 5.4 million people with asthma but many may be suffering from other respiratory diseases or allergies.
Asthma UK said there is also evidence asthma is under-diagnosed too - and that eight out of 10 asthma sufferers are still not getting the correct basic care.