Asthma

Leading Australian respiratory physician agrees childhood asthma is over diagnosed

Thursday, 14 Apr 2016


Over diagnosis of childhood asthma and inappropriate prescribing is rife in Australia, while children continue to die unnecessarily from the disease, says a leading respiratory physician.

Professor Adam Jaffe, John Beveridge Professor of Paediatrics and Head of Discipline of Paediatrics at the University of NSW, and Consultant in Respiratory Medicine at Sydney Children’s Hospital comments follow an article in the Archives of Disease in Childhood journal, in which UK-based respiratory doctors claimed inhalers were often dispensed for no good reason, and had “almost become a fashion accessory”.

Authors, outspoken Professor Andrew Bush, and Dr Louise Fleming, of Imperial College and Royal Brompton and Harefield NHS Foundation Trust, said that while asthma had in the past been undoubtedly under-diagnosed, evidence suggested the pendulum had swung too far in the opposite direction.

“We propose that one contributing factor is that the diagnosis of asthma has been trivialised and inhalers dispensed for no good reason, and have become almost a fashion accessory,” they wrote. “The result is that asthma is a killing disease if not correctly managed, is overlooked.”

Professor Jaffe, who has previously worked with Professor Bush, stopped short of endorsing the view that inhalers had become fashion accessories, but said they made good points about over diagnosis and the misuse of inhalers.

“Definitely asthma is over diagnosed – I would completely agree with him on that,” he told the limbic.

He said one of his favourite jobs was ‘undiagnosing’ asthma in young patients.

“Just because you cough doesn’t mean you have asthma,” he said.

While inhaled corticosteroids, when properly used, can reduce the risk of asthma attacks, they do come with potential known side effects, including growth suppression.

Professor Jaffe supports the easy access to medication, but stressed it was vital that patients were regularly monitored and followed up. He said it was important for patients – and in the case of children their parents or carers – to understand the importance of maintaining a properly developed management plan when a proper diagnosis is made.

“I think people have become a bit complacent – children still die from asthma,” he said. “Thankfully it’s rare but it does happen.”

He highlighted a review of asthma deaths in the UK that showed some children who died from the disease lacked basic asthma management plans, and had not taken medication as prescribed.

“We know that a significant number of health practitioners in Australia don’t even use the national guidelines,” he said. “This is a major problem.”

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