DO YOU REALLY HAVE ASTHMA?
7/12/2017, noon | Updated on 7/12/2017, noon
DO YOU REALLY HAVE ASTHMA?
By Christopher Shuttlesworth
“At first, I was like, doc you’re kidding?”
It is the response you’d expect from anyone who has been told their entire life that they had asthma, only to find out that they had been misdiagnosed. According to Dr. Edward Lisberg, Director of research at the Asthma and Allergy Center of Chicago, respiratory experts estimate that 1 out of every 3 people who have been told they have asthma have actually been misdiagnosed.
“It’s incredible of the amount of misdiagnosis out there, ” Lisberg said. “We see kids exercising with asthma, but they don’t have asthma at all.”
A series of published studies conducted by Canadian researchers over the past decade demonstrate that at least 30% of patients diagnosed with asthma, some who had been taking medication for decades, were misdiagnosed. In the U.S., that equates to millions of people who are misdiagnosed with asthma, representing tens of millions of dollars spent on unnecessary medications and medical care.
“Before you put someone on a medication, make sure you’re treating the right symptom,” Dr. Lisberg said.
Some experts rationalize that it is “logical” or “expected” for general doctors or pediatricians to assume that most patients, especially children, with a persistent cough or other breathing symptoms must have asthma, he said. In fact, many general physicians simply believe that anything that causes wheezing or
shortness of breath must be asthma, he added.
“I had a physician’s wife who spent five days in the hospital for her asthma, but the doctor never checked her lungs functioning system because he was so convinced that she had asthma,” Lisberg said, adding, “but she had no asthma at all.”
The medical community does not like being critical of itself, Lisberg added, which is the main problem, he said.
“I’ve had doctors literally argue with me saying ‘I don’t need to check their lung functioning test. I know what asthma is.’ “
So why are so many people misdiagnosed? In a few cases it can be difficult to establish an asthma diagnosis, but these cases are clearly the exception.
“You can sugar coat it all you want, but the responsibility falls entirely on doctors,” says Lisberg. “In a nutshell, the problem with physician misdiagnosis of asthma stems from a combination of poor training, lack of knowledge, and poor medical judgement. It seems that rarely do general physicians have a systematic approach to
evaluating wheezy, coughing, or breathless patients.”
He explained that the spirometry test, which is used to check how well the patient’s lungs are working, is the test every single medical organization has said should be used during every patient’s diagnosis, but it’s just not done.
“It’s not a cost issue because it’s a very low-cost test,” he said. “The problem is that the physicians over the training programs don’t even know how to conduct the spirometry test.”
According to both U.S and International Guidelines, asthma cannot be accurately diagnosed without doing spirometry. Spirometers can and should be used in any medical once which treats people for respiratory symptoms, especially to diagnose asthma. Symptoms, physical examination, and using other devices (such as portable plastic peak flow meters) are not reliable in
diagnosing asthma. In Canadian research studies, fewer than 50% of patients diagnosed with asthma ever had spirometry.
In the U.S, the majority of patients with asthma (and COPD) treated in primary care oªces have never had a spirometry test. In fact, among all U.S. doctors who see patients for respiratory problems, Family Practice physicians are the least likely to use spirometers, according to an Asthma and Allergy Center of Chicago
“I have been dumbfounded and frustrated that in the twenty-plus years I have been affiliated with a number of local hospitals’ Family Practice and Internal Medicine training programs that none of their clinics have spirometers. On a local level, it brings into focus the complete disconnect between established guidelines,
specialist care practices and the actual practice by general medical doctors” Lisberg said.