30 per cent asthmatics likely mis-tested; Poor testing, mis-diagnosis blamed
Hyderabad: Over diagnosis and misdiagnosis of asthma was as high as 30 per cent because, say pulmonologists, the diagnosis is often done without performing the spirometry test that is important to confirm asthma. Asthma is a chronic inflammatory disease of the airways, making it difficult for air to move in and out of the lungs.
Common clinical presentations that mimic asthma are chronic obstructive pulmonary disease (COPD), which is due to smoking, acid reflux, sleep apnea or snoring, heart diseases, tuberculosis and pneumonia. These can be wrongly diagnosed as asthma.
Dr B. Chaithanya, consultant pulmonologist and intensivist, explained, “In India the common notion is that wheezing is equal to asthma. More than 40 per cent of wheezing problems are due to various other reasons or underlying ailments, but they are completely misdiagnosed and the patient is put on asthma medications. Thirty per cent of the cases referred to pulmonologists for bronchitis asthma are found to be misdiagnosed.”
Spirometry or pulmonary function test must be carried out to diagnose asthma, but more than 50 per cent of asthmatics are diagnosed without carrying out this test.
“There are various reasons for this,” said Dr Vijay Kumar C, consultant interventional pulmonologist, “like the lack of equipment at many centres and a dearth of qualified technicians to perform the test. There is also lack of knowledge among physicians to interpret the test results, which is a major drawback. There are alternatives like the peak flow meter, which is simple to use and affordable, and which must be insisted upon so that the over diagnosis can be prevented."
Over diagnosis of asthma, and the strong medications that are prescribed as a result, can have major side-effects; patients can develop secondary illness due to these medications.
India has 10 per cent of asthmatics
An estimated 20 million people suffer from asthma in India. This is 10 per cent of the global burden of 200 million asthmatics worldwide. Every year there are 2 lakh deaths due to asthma around the globe.
The prevalence of asthma is 15 per cent in adults and 5 to 7 per cent in children in India. Sixty per cent of patients are referred to pulmonologists, but the rest 40 per cent are diagnosed and treated at the periphery levels, mostly by general physicians and RMPs where the over-diagnosis and mis-diagnosis is found.
Dr P.N. Reddy, senior pulmonologist, said, “Many asthma patients have normal lung function in between the episodes and only during the asthma attacks do they have the symptoms. These patients can’t be put on medication all the time. Only in severe cases should the medications be used and not in mild to moderate attacks. This is where the problem lies and hence the whole question of over-diagnosis or mis-diagnosis has emerged.”
