- NICE says there is no evidence a third of asthma patients have the disease
- Watchdog is concerned they are receiving treatment they don’t need
- Now advises doctors to carry out clinical tests before diagnosing patients
- This includes a spirometer – which measures volume of airway obstruction
- However asthma charities say patients aren’t receiving adequate care
More than a million people receiving treatment for asthma may have been misdiagnosed, experts warned today.
Almost a third of the 4.1m people treated for asthma in the UK did not show any ‘clear evidence’ of the incurable condition, according to the National Institute for Health and Care Excellence (NICE) .
This means they may be receiving unnecessary treatment.
However, asthma charities warned diagnosing asthma is difficult and the majority of patients ‘do not receive adequate care’.
And experts cautioned that no one diagnosed with the condition should stop taking prescribed medication unless instructed by a healthcare professional.
More than a million people may have been wrongly diagnosed as having asthma – and may be receiving unnecessary treatment
NICE has drafted new guidance, its first for asthma, for doctors in England to improve the accuracy of diagnoses.
The guideline makes it clear that a clinical test should be carried out to diagnose asthma, as well as checking for signs and symptoms.
It said the first test should be carried out using a spirometer, a machine which measures how much and how fast a person breathes out.
Further breath tests should be carried out depending on the results from spirometry and the patient’s age.
For adults and young people over five years, an FeNO test should be carried out.
This is a test which checks for levels of nitric oxide, a gas which is found in larger volumes in people with asthma.
A BDR test4 which measures whether standard medicines which widen the airways of the lung are of benefit
WHAT IS ASTHMA?
Asthma is a common long-term condition that can cause coughing, wheezing, chest tightness and breathlessness.
The severity of these symptoms varies from person to person.
Asthma can be controlled well in most people most of the time, although some people may have more persistent problems.
Occasionally, asthma symptoms can get gradually or suddenly worse. This is known as an ‘asthma attack’, although doctors sometimes use the term ‘exacerbation’.
Severe attacks may require hospital treatment and can be life threatening, although this is unusual.
Asthma is caused by inflammation of the small tubes, called bronchi, which carry air in and out of the lungs.
When a person come into contact with something that irritates the lungs – known as a trigger – the airways become narrow, the muscles around them tighten, and there is an increase in the production of sticky mucus (phlegm).
The reason why some people develop asthma is not fully understood, although it is known that a person is more likely to develop it if they have a family history of the condition.
Asthma can develop at any age, including in young children and elderly people.
Source: NHS Choices
The treatment of children under five should be based on professional judgement and observation until the child is old enough to take clinical tests.
Around 1 in 10 of adults with asthma develops the condition because they are exposed to certain substances, such as chemicals or dust, in their workplace.
The draft guideline also recommends that healthcare professionals ask employed people how their symptoms are affected by work, to check if they may have occupational asthma.
During each review, the healthcare professionals should check the patient is able to use their inhaler correctly and also consider using a questionnaire to get a better estimate of how well a person is doing, it added.
Professor Mark Baker, director of clinical practice at NICE, said: ‘Asthma is a long-term incurable condition that affects millions of people of all ages.
‘If left untreated, asthma attacks can be life threatening.
‘However, with appropriate treatment and thoughtful monitoring, most people will be able to successfully control their symptoms and be spared from serious harm.
‘Accurate diagnosis of asthma has been a significant problem which means that people may be wrongly diagnosed or cases might be missed in others.
‘Our aim with this guideline is to give clarity and set out the most clinical and cost effective ways to diagnose and monitor asthma based on the best available evidence.’
Asthma is one of the world’s most common long-lasting diseases in childhood, affecting 1.1m children and 4.3m adults in the UK.
Around 10 per cent of the 5.4 million people in the UK with asthma have the most severe form, which leaves them unable to control their symptoms, resulting in frequent attacks, despite taking multiple high-strength medicines.
Experts today highlighted the need for respiratory diseases to be diagnosed accurately.
Professor Anna Murphy, a consultant pharmacist and spokesperson for the Royal Pharmaceutical Society said: ‘I think there are issues in primary care in diagnosing asthma.
NICE says doctors should now carry out clinical test as well as observations in order to diagnose asthma. The first test should be carried out using a spirometer, a machine which measures how much and how fast a person breathes out (pictured)
‘We need to do a thorough history and do objective tests to confirm the findings we suspect.
‘Unfortunately we’re often not doing these tests and so people are being misdiagnosed.
‘Getting the diagnosis right before we get suggest treatment for any disease is important.
‘If we’re given asthma treatment for breathlessness and it’s not working, it could be that the person has COPD, anaemia, or heart failure, which will need to be treated appropriately.
‘Other people with these conditions could slip through the net.’
There aren’t too many risks for people taking inhalers at the doses generally prescribed by doctors and pharmacists, she added, but as they are steroid inhalers they could induce side-effects of oral thrush and a hoarse voice.
‘There’s also a cost to the NHS of wasted treatment,’ she continued.
However, she said asthma can be fatal and so stressed people diagnosed with the condition should not stop their treatment without the advice of a healthcare professional.
‘We can’t miss the fact that people die from asthma, so I don’t want people to think “I don’t have asthma” and stop their treatment.
‘It’s a variable disease which will be well-controlled at some points, but they will have symptoms such as breathlessness, coughing at night, and wheezing at other times.
Experts said people misdiagnosed with asthma could actually be suffering breathlessness for a different reason, such as COPD, lung diseases anaemia or heart failure, which should be treated appropriately
‘What we would recommend for anyone with well-controlled disease, is that it’s good practice for the healthcare professional to slowly start reducing their treatments, in a controlled way, so the need less.
‘They would be monitored to make sure people are safe.’
Dr Nick Robinson, a respiratory physician and medical advisor for the British Lung Foundation echoed these concerns.
He told Mailonline: ‘Tens of hundreds of thousands of people are taking inhalers they don’t need is wasteful.
‘Some people with asthma could end up with high doses of inhaled steroids, when the correct dose for them is zero.’
Commenting on the draft guideline, Kay Boycott, chief executive at Asthma UK, said: ‘We welcome the NICE guideline for the improvement of asthma diagnosis in the hope that this will help people with asthma receive more personalised care.
‘Asthma has many complex causes which is one of the reasons why it is sometimes difficult to get a definitive diagnosis.
‘It is also a highly variable condition that can change throughout someone’s life or even week by week, meaning treatment can change over time.
‘For anyone with an asthma diagnosis, it is vital they have the right medication and a plan to better manage their condition and any asthma attacks.’