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Reassessing Asthma Diagnosis in Some Patients

JAMA; 2017 Jan 17; Aaron, et al

Publish date:

Reassessing physician-diagnosed asthma may be warranted in some adult patients, according to a recent study. The multicenter cohort of 701 randomly selected adults with physician-diagnosed asthma from January 2012 to February 2016 sought to determine whether a diagnosis of current asthma could be ruled out and asthma medications safely stopped in this patient population. Researchers found:

  • 613 patients competed the study.
  • Current asthma evaluation included pre- and post-bronchodilator assessment, methacholine challenge testing, and weaning of medicine with no exacerbation over 12 months of follow-up.
  • Asthma was ruled out in 203 of 613 (33.1%) participants.
  • 181 (29.5%) participants continued to exhibit no clinical or laboratory evidence of asthma after an additional 12 months of follow-up.
  • Participants in whom current asthma was ruled out were less likely like to have undergone testing for airflow limitation in the community at time of initial diagnosis vs those in whom asthma was confirmed (43.8% vs 55.6%).

Citation:

Aaron SD, Vandemheen KL, FitzGerald JM, et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269-279. doi:10.1001/jama.2016.19627.

Commentary:

Patients carrying the diagnosis of asthma who do not appear to have asthma when carefully assessed probably fall into 1 of 2 categories. Some of the patients have likely gone into a period of remission and are able to be weaned off of their medications. They may have an exacerbation or recurrence of their asthma at some point in the future. A separate cohort consists of patients probably diagnosed after a viral- or allergen-induced episode of wheezing and do not truly have asthma. We know that asthma is a disease with variable severity over time, and this study underscores that point. It also supports and emphasizes the importance of the recommendations made in the current asthma guidelines that patients who have had stable asthma and who have not had symptoms should periodically have a step-down of therapy in order to use the least amount of asthma medication over time.ˡ —Neil Skolnik, MD

  1. National Heart, Lung, and Blood Institute. National Asthma Education and Prevention Program expert panel report 3: guidelines for the diagnosis and management of asthma. 2007 Aug. Report No.: 07-4051.

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