Asthma Diagnosis Masqueraders and Outliners
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I was recently asked by an acquaintance who was trying to learn more about asthma,”What life with asthma is like and how did I know it was asthma?” It has been a while since I have thought about the diagnosis process. To some degree I think I have blocked out that crazy journey. It is important to note that not everyone will have the same diagnosis process, based on my physicians, testing that was available my journey had a few speed bumps in it.

I remember being initially filled with doubt and confusion about the process. Honestly, I knew very little about what the diagnosis process entailed. I remember thinking asthma seems too simple of a diagnosis and should I not feel better, if it was asthma? Don’t hate me, I was incredibly naive, when my doctor refused to perform or request some diagnostics. I now know better and if you are a regular reader, you know that I am passionate that patients should and can advocate for themselves, with their doctors.

There were so many things that I did not know. I would have done anything to have had a comprehensive site like Asthma.net to help guide me. Instead I navigated a crazy path with my family doctor, community specialist and then a not so positive experience with my community specialist. This was also the time that I got smart. I had to research and seek out other options for care and diagnostics. I learned about masqueraders and other similar and outliner diagnosis. Until I was going through the process, I was not aware of all the things that could present “like” asthma. Here is a snap shot of Differential diagnosis that may be ruled in or out, when confirming an asthma diagnosis. It is important to know that some of these may exist in addition to your asthma.

Potential differential diagnosis are: Alpha 1-Antripysin Deficiency, Anxiety, Aspergillosis, Bronchiectasis, Bronchiolitis, COPD, Chronic Sinusitis, Eosinophilic Granulomatosis with Polyangitis (Churg Strauss Syndrome, Cystic Fibrosis, Gastroesophageal Reflux Disease and Vocal Cord Dysfunction to name a few. 1 There are more and with your doctor you will be able to determine if any of these masqueraders are playing a role in your diagnosis.

It is important that your physician does a full work up including spirometry, which is part of a group pulmonary function tests. While the test alone may not fully confirm diagnosis that are thought to be integral.2 A study that came out early in the year found that one third of people who were recently diagnosed with asthma, may actually not have it.

“From January, 2012, to February, 2015, the researchers looked at more than 600 people in Canada’s 10 largest cities and their surrounding areas who were diagnosed with asthma in the five years before they joined the study.The researchers tested patients and reduced their medication use to assess whether the diagnoses were accurate, and determined that 203 of 613 participants did not have active asthma.”3

After one year, the study found that 90% of patients that did not have asthma were able to stay off of medication. Less than half of the patients diagnosed with asthma were found to have had spirometry at time of diagnosis.The study has now raised questions about the lack of access to test that patients are encountering.

What are your diagnosis stories? I would love to hear them.

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