Remember back in circa mid-January, when almost every other health headline read that about one-third of all adults diagnosed with asthma actually don’t have this respiratory disorder at all? You probably do. The publication featured everywhere, from the Chicago Tribune to Fox News Health.
A Close Look at the Case Study
Let’s scrutinize the study; which admittedly has notable merit and is a good one. Canadian researchers sought and enlisted 615 random individuals who all were diagnosed with the respiratory disorder, asthma. They carried out formal tests to determine if these people still had the disorder. In point of fact, about 33% of those individuals, subject to the researchers’ formal tests, didn’t conform to the decisive factors for the diagnosis of asthma at the testing time. This study’s lead author is quoted pointing out that the respective health practitioners diagnosed their patients with asthma without conducting all of the necessary tests.
What! Well, as a healthcare physician who diagnoses and treats asthma (including its many variants), a medical writer and researcher who scrutinizes these medical articles, and as someone who currently holds a familiarity to awful asthma flares, or exacerbation, I am concerned with these publications, as well as the lead author’s press statements.
Taking a Deeper Look
The devil is always in the details. Of the one-third participants who tested negative for asthma in this study, about 12% of them actually were subject to all the appropriate tests, to confirm asthma, when first diagnosed. Furthermore, about 22 individuals of the participants who tested negative for asthma at the time of the study, were diagnosed again with this chronic respiratory disorder months later (of course using appropriate testing this time round).
What exactly does this mean? Like most of the chronic diseases, asthma holds many forms, and its symptoms may come and go. So, is this consistent with my professional conclusions or my personal experience? It probably is a pinch of both.
At the start of this study, the authors acknowledge that asthma is a tricky chronic respiratory disorder to manage, pointing out there are multiple forms of asthma, which can look quite different and have assorted triggers. They go on to point out (as per the editorial) that asthma symptoms can relapse and remit.
The Reality about Asthma
According to research by the Centers for Disease Control and Prevention, asthma is a chronic respiratory disorder which affects about 6 million American children. In case one’s airways are inflamed – by an infection, exercise or allergens, for instance – they constrict and moderate one’s airflow.
When a patient approaches my primary healthcare office with coughing and/or wheezing seizures, especially those whose symptoms better with a nebulizer treatment in the clinic, I let them know that at the very least they have the reactive airways syndrome. As it happens, this isn’t exactly asthma. It simply means that something provoked the wheezing and/or coughing spasms. Best case scenario, they may never wheeze and/or cough again. However, right then and there in my office, because the patient is wheezing, an inhaler will most probably be of aid. In case the inhaler has been effective on the patient in the past, or if the nebulizer presents an immediate relief to the wheezing patient, I’m not going to say, “Oh, wait! I have to carry out the necessary formal tests, before I treat you.” No way.
Nevertheless, if the patient’s symptoms persist and I’m worried that the wheezing and/or coughing seizures is more than an occasional indicator, then I may want to tail a formal, medical diagnosis of asthma.
How to be Certain it’s Asthma
To diagnose asthma, a pulmonologist requires two things; a historic account of respiratory symptoms conforming to asthma (chest tightness, coughing spasms, especially night-time cough, wheezing) as well as evidence of ‘variable expiratory airflow obstruction.’ You probably are wondering what the heck this is.
Well, formal lung function tests can point out whether the constriction and inflammation of the airways impends your ability to breathe out. A vital piece of equipment for conducting the lung function tests is a spirometer. Unlike the peak flow meter that you can purchase at a drug store, you won’t find the spirometer in every other primary care office. I refer my patients to the pulmonary function lab for the formal lung function tests.
In the pulmonary function lab, the patient will have to breathe into the spirometer while the equipment assesses the patient’s total lung capacity, including his or her exhalation speed. The patient may also be subject to inhaled medications which go a long way to help diagnose asthma. At times, the doc may issue medications, such as albuterol to see if they help relieve the patient’s symptoms or the medication methacholine to carefully trigger an asthma attack. If the albuterol helps relieve the patient’s symptoms or if methacholine provokes an asthma attack – then, diagnosis is made.
Understandably, formal tests may be too expensive for some patients, or situations may coerce them to fail to schedule the formal testing in time. In the case that the patient’s historic account is as clear as mine, it’s more sensible to issue him or her asthma diagnosis.
Why is this? The insurance can cover the patient’s use of medical equipment such as the nebulizer machine. Even though formal tests confirms that the patient has this chronic respiratory disorder, asthma’s symptom can remit on their own, and reiterate formal testing can surprisingly be negative later on. What! Could this probably be a misdiagnosis? Hell no. This was just asthma.
Asthma in Actual Life
What of me? Well, I was in my doc’s office yesterday with wheezing. I was down with flu last week which provoked lengthened coughing spasms/ wheezing episode. My doc noticed my breathe struggle, assessed my oxygen levels – which were significantly low. He also assessed my peak flow, which got better once he issued a nebulised albuterol treatment. This all necessitates an asthma diagnosis, but I’m currently written off as having reactive airways – all because I haven’t had any formal tests by a pulmonologist. Yes. I have never had a spirometry evaluation thus yet.
Since this is about the fifth time the symptoms have recurred, my doc is of the opinion that I should pursue a more formal diagnosis. Guess what? I already have a referral for my pulmonary function tests sometime in the near future. However, I’m currently sick, so he simply has me on treatment.
“The truth is, you can’t always foresee when a problem will arise,” says Daniel Ward, my doctor. “Asthma’s erratic nature makes it really tough to manage.”