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. 2016 Mar;66(644):e152-7.
doi: 10.3399/bjgp16X683965.

Overdiagnosis of asthma in children in primary care: a retrospective analysis

Ingrid Looijmans-van den Akker  1 , Karen van Luijn  1 , Theo Verheij  2
Affiliations

Overdiagnosis of asthma in children in primary care: a retrospective analysis

Ingrid Looijmans-van den Akker et al. Br J Gen Pract. 2016 Mar.

Abstract

Background: Asthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged >6 years. Previous studies indicate that asthma in children is probably overdiagnosed. However, the extent has not previously been assessed.

Aim: To assess the extent and characteristics of confirmed and unconfirmed diagnoses of asthma in children who were diagnosed by their GP as having asthma or who were treated as having asthma.

Design and setting: Retrospective analysis in four academic primary healthcare centres in Utrecht, the Netherlands.

Method: Routine care registration data of children aged 6-18 years who received a diagnosis of asthma or were treated as having asthma were analysed.

Results: In only 16.1% (n = 105) of the children diagnosed with asthma was the diagnosis confirmed with spirometry, whereas in 23.2% (n = 151) the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests. In more one-half (53.5%, n = 349) of the children the signs and symptoms made asthma unlikely and thus they were most likely overdiagnosed. The remaining 7.2% (n = 47) were probably correctly classified as not having asthma. The main reasons for classifying asthma without children undergoing further lung function tests were dyspnoea (31.9%, n = 174), cough (26.0%, n = 142), and wheezing (10.4%, n = 57).

Conclusion: Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.

Keywords: asthma; children; diagnosis; guidelines; respiratory function tests; spirometry.

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Figures

Figure 1.
Figure 1.
The number of children with and without ICPC code R96 (asthma) divided into the categories: confirmed asthma, probable asthma, unlikely asthma, and no asthma.
Figure 2.
Figure 2.
Percentage breakdown of the various asthma diagnosis categories.
Figure 3.
Figure 3.
Diagnostic criteria for children’s asthma diagnosis (ICPC R96).
Figure 4.
Figure 4.
Types of chronic inhalation medication used.
See this image and copyright information in PMC

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References

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