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Diagnosis: How reliable in clinical practice are symptom-based tools vs other investigations for diagnosing asthma?
Two significant problems exist with regard to asthma diagnosis that of under-diagnosis 2,3,4,5,6,7 and misdiagnosis.8
Under-diagnosis may be due to patient factors such as failure to consult with symptoms or physician factors such as failure to consider a diagnosis.
Misdiagnosis as asthma may occur where objective assessment is not made.4 This can be due to lack of interest, lack of training or lack of resources.6
The IPCRG guidelines suggest a range of symptom-based tools and investigations including peak flow monitoring, reversibility testing and hyper-responsiveness assessment.9 Information on the sensitivity, specificity, positive and negative predictive value of such tools is urgently needed to inform best practice in primary care. Comparison to standard diagnostic tools such as spirometry, peak flow measurements and challenge tests are necessary. The availability of these tests compared with universal availability of questionnaires needs to be highlighted.
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