Say What? "Patients Without a Proper Workup Do Not Have Asthma "

I recently attended an asthma conference and one of the speakers made this statement and it caught me a bit off guard. I always just assumed that everyone that says they have asthma has had a proper workup done. As many of you know, not everyone's experience with diagnosis is the same. There has been some discussion between patients that they have never had lung function testing. There are many patients who want to have lung function tests and don't have access. There are even physicians who're in constant battles with their own healthcare system to get access to equipment for their patients.

As patients, how do we know where to begin?

Even as an empowered patient, it was difficult at the beginning to question my doctor about their thoughts and diagnosis. I know that there were times when I just wanted to desperately feel better and how we got to a diagnosis or label it was less important. What I didn't know was that thinking that could be harmful. No one wants to take meds that they don't need to be taking or be five years into a diagnosis that they did not really have.

Let's start at the beginning with a refresher on the definition of asthma. Asthma may be suspected if there is a positive medical history of dry coughing, wheezing, chest tightness or shortness of breath. Did you know that although bronchial hyperresposiveness is often a symptom, the current GINA guidelines no longer include it as a criteria for diagnosis? ²

What is considered to be a proper asthma workup?

There are a few components that are thought of as being part of a proper workup. Of course this would start with history and physical exam but also includes lung function testing.   This testing can confirm a diagnosis of airway obstruction. Airway obstruction should be reversible as demonstrated by a 12% and 200 ml in adults after  200-400mg of salbutamol. If your doctor suspects you have asthma and your lung function is normal, you may also have a methacholine challenge test that will look at bronchial hyperresponsiveness in adults. A diagnosis is considered to be positive for asthma if after 4 weeks of anti-inflammatory therapy, there is an increase in lung function (FEV1) on 12% or 200ml. An allergen trigger test should also be completed if allergy is suspected.

It is not a common practice or has been made part of the guidelines yet, however the use of fractional exhaled FeNo (nitric oxide) may be used in some practices. It is thought to be important to guide steroid responsiveness as an inflammation in some patients.

It is important that patients receive an accurate diagnosis. It is easy to label certain symptoms as asthma, however the physician needs to ensure that a proper workup in completed to confirm diagnosis and treatment and also to protect patients from being on medications that they do not need to be.