Experts warn that thousands of people diagnosed with asthma do not have the condition, meaning they are taking unnecessarily powerful steroids and risk overlooking other life-threatening conditions.
To meet criteria for an asthma diagnosis, lung capacity must be below a certain threshold, which can be measured with a device called a spirometer, which monitors how much air you can exhale. But poor access and a lack of machinery have left doctors relying on less accurate methods.
Instead, patients can be diagnosed based on symptoms and the results of a test called a peak flow test, a much simpler measurement of lung capacity.
Dr Azeem Majeed, Professor of Primary Care and Public Health at Imperial College London, says: “Asthma can be difficult to diagnose as there are many other conditions with similar symptoms. That is why it is important to perform several tests. It doesn’t always happen because GPs can’t find the right one.’
The warnings follow a study published in the British Medical Journal, which estimated that around a third of asthma patients could be misdiagnosed.
Misdiagnosis prevents patients from being treated for possible conditions including dangerously high blood pressure, coronary artery disease – when the arteries that supply the heart are narrowed – and chronic obstructive pulmonary disease (COPD), when the lungs are inflamed and damaged.
Father-of-two Tom Packham, 27, from Lancashire, was wrongly diagnosed with asthma while suffering from potentially life-threatening pulmonary hypertension
Mr. Packham, along with his family, said asthma treatment worsened his underlying condition
Around eight million Britons have been diagnosed with asthma and around five million are being treated. The condition develops when the airways that carry air in and out of the lungs become inflamed and tender, causing them to temporarily narrow, resulting in shortness of breath and chest tightness.
Usually it is treated with inhalers. Most patients are given a blue inhaler containing a drug called sabutimol, which relaxes and opens the airways. Some patients are also given preventative inhalers, which contain steroids to reduce inflammation and swelling, or an inhaler that combines both. However, it carries the risk of fungal infections in the throat and mouth and can cause a sore throat.
When inhalers do not control asthma symptoms, patients are switched to stronger treatments, including high-dose steroids and other drugs that can cause serious side effects. With long-term use, steroids can increase the risk of osteoporosis – weak bones – and high blood pressure.
However, experts say many patients treated with the stronger drugs do not have asthma. “If a patient doesn’t respond to treatment — which usually doesn’t happen if they don’t have asthma — the dose can always go up, increasing the likelihood of side effects,” said Andrew Bush, professor of pediatric respiratory medicine. at the National Heart Institute and at the Pulmonary Institute at Imperial College London.
“The drug can stunt children’s growth and prevent the body from producing hormones such as cortisol, which are essential for the brain’s nutrient absorption.”
Experts say misdiagnosis has been around for a long time, but the Covid pandemic has exacerbated the problem. Because spirometry tests carried out in GP offices were suspended in 2020 and 2021 because they were classified as high risk.
In some areas, testing capacity has not yet returned to pre-pandemic levels, says Prof Majeed. “They are funded by local health chiefs, not individual GPs,” he adds. “Some local teams haven’t invested in bringing back tests for every practice because it’s expensive.
“Also, some doctors are not trained in the machines, while others have the machine but don’t have the staff to use it.”
This means that doctors diagnose asthma based on symptoms and the results of a peak flow test – but the result can change if a patient has exercised or is stressed or tired.
One patient abused for asthma was Tom Packham, 27, from Lancashire. In February, the father of two called his doctor complaining of shortness of breath and dizziness. He was told to monitor his lung function at home with a peak flow machine and the results were used to diagnose asthma. He was given a preventative inhaler and a blue inhaler for shortness of breath.
But his symptoms worsened. The doctors offered another inhaler with stronger steroids.
Tom says: “At first the nurse said I wasn’t using the inhaler correctly, then they gave me a stronger one. I barely saw the doctor or nurse face to face, which didn’t help either. I kept trying to tell them it wasn’t asthma, but they insisted.”
Within a few months, he became so dizzy that he had trouble walking and passed out twice. His family doctor sent him for an examination, which revealed that there were problems with the blood vessels supplying blood to his lungs. He was diagnosed with pulmonary hypertension – high blood pressure that can lead to heart failure.
Tom is on medication for his condition and can now walk relatively comfortably, but he still doesn’t know what the future holds. “I try to stay positive,” he says.
Prof. Majeed emphasizes that patients should not stop their asthma medication without consulting a family doctor.
“Sometimes doctors have to give medication, even if they are not sure of the diagnosis, to rule things out,” he says. “But the screening of patients is crucial. If the drug doesn’t work, the diagnosis can be wrong.”
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Crystal Leahy is an author and health journalist who writes for The Fashion Vibes. With a background in health and wellness, Crystal has a passion for helping people live their best lives through healthy habits and lifestyles.
