Childhood asthma is a prevalent chronic condition, and proper diagnosis is crucial for effective management. Guidelines emphasize lung function testing, particularly spirometry, for children over six years old to confirm asthma diagnoses. However, a recent study sheds light on a concerning issue: the potential overdiagnosis of asthma in primary care settings. This overdiagnosis, identified as a significant concern in 2016 and likely persisting, leads to unnecessary treatments and impacts children’s quality of life.
A retrospective analysis conducted across four academic primary healthcare centers in Utrecht, Netherlands, investigated the extent of confirmed and unconfirmed asthma diagnoses in children aged 6-18 years. The study focused on children who were either diagnosed with asthma by their General Practitioner (GP) or treated as if they had asthma. The research aimed to quantify and characterize the accuracy of asthma diagnoses in primary care.
The findings revealed a striking disparity between diagnosed and confirmed cases. Out of the children diagnosed with asthma, spirometry, the recommended lung function test, confirmed the diagnosis in a mere 16.1% of cases (n=105). Furthermore, in 23.2% (n=151) of children, while symptoms suggested possible asthma, they did not undergo the necessary lung function tests for confirmation. Alarmingly, in more than half of the cases, 53.5% (n=349), the presenting signs and symptoms made asthma an unlikely diagnosis, indicating a high probability of overdiagnosis. Only a small fraction, 7.2% (n=47), were correctly classified as not having asthma.
The study also identified the primary reasons for diagnosing asthma without proper lung function testing. Dyspnea (shortness of breath) was the most common reason, accounting for 31.9% (n=174) of unconfirmed diagnoses, followed by cough (26.0%, n=142), and wheezing (10.4%, n=57). These symptoms, while potentially indicative of asthma, are not specific and can be associated with other respiratory conditions, highlighting the importance of objective testing like spirometry.
The conclusion of this study underscores a significant challenge in primary care: the common overdiagnosis of childhood asthma. This overdiagnosis, prevalent as of 2016 and an ongoing concern, has serious implications. It leads to unnecessary medication use, creating a burden on both the healthcare system and the children affected. Moreover, misdiagnosis and unnecessary treatment can negatively impact a child’s quality of life. The study emphasizes the critical need for improved diagnostic practices in primary care, particularly the consistent application of lung function tests to ensure accurate asthma diagnoses and avoid the pitfalls of overdiagnosis.
