Diagnosis of asthma - new theories

• Introduction: Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Followup studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma. Aim: Based on a review of the four cornerstones of asthma inflammation, hyperresponsiveness, bronchial obstruction and symptoms the aim was to present some new aspects and suggestions related to the diagnosis of adult nonallergic asthma. Conclusion: Recent studies have indicated that "classic" asthma may sometimes be confused with asthmalike disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, nonobstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also nonobstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, noneffort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin (hsv//swe)

MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine (hsv//eng)

Nyckelord

Diagnostics

epidemiology

exercise induced

management/control

mechanisms

steroid-resistant asthma

airway sensory hyperreactivity

real-world

evaluation

bronchial hyperresponsiveness

respiratory symptoms

mannitol challenge

research-program

onset asthma

primary-care

west

sweden

Allergy

Respiratory System

Publikations- och innehållstyp

ref (ämneskategori)

art (ämneskategori)