Is It Really Asthma?
I'm sure I'm not the only one who has asked myself this question. Since I've never had a methacholine challenge I occasionally have this self-doubt that maybe it's all in my head. I'm not actually asthmatic. Those coughs and that chest tightness aren't really real. Of course, the logical side of my brain knows that a well respected competent doctor made this diagnosis. In all likelihood, it is asthma like my care team believes it to be. However, if it turns out they were wrong I would be in good company.
Incorrect Asthma diagnosis
The Journal of the American Medical Association recently published a study where researchers reevaluated adults with asthma to confirm the diagnosis. About one-third of adults who completed the study were found to have an incorrect asthma diagnosis.1 They did extensive testing of adults with an asthma diagnosis to confirm it and even tried weaning people off their asthma maintenance meds where appropriate. The research showed that asthma was more likely to be ruled out rather than confirmed if the patient had not been tested for "airflow limitation in the community at the time of initial diagnosis."1 I assume that is researcher-speak for the doctor didn't make you blow out the spirometry birthday candles on the computer when they diagnosed you. I personally could be part of this group, while I've done plenty of spirometry over the years I didn't do any before steroid inhalers.
Medicine is as much an art as a science
To me, this study speaks to how medicine is as much an art as a science. I trust my care team to make good judgment calls to inform my treatment. I am reminded that while they are doing their best with the evidence available to them we are all only human. If I ever get to a place in my asthma control where we can completely step down off of daily medications I would be very interested to see my asthma diagnosis reconfirmed. It would be nice to have the little voice of doubt the back of my head laid to rest once and for all. If it were found to be an incorrect diagnosis I would be slightly upset to have gone through so many years of treatment for nothing. While I think that the treatments we have chosen along the way are reasonable, they are not without risks. The risks to me outweigh the benefits of uncontrolled asthma. That is, of course, assuming I have asthma. The risks of asthma medications are not worth it to me if I do not have asthma. I assume most people would agree that treatments are only worth their risk if there is actually a problem to be remedied. Ultimately I will trust my medical team's diagnosis. If I question the initial result why should I accept a later test result as valid (After all either could be a false positive or negative)? As a person who is accepting of science, I will listen to the results presented to me by my team. Do you doubt your diagnosis? Have you sought additional resources to try to resolve your feelings about the diagnosis?
How does your asthma change with the seasons?