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Over one million adults may be misdiagnosed with asthma – NICE

More than one million adults in the UK may have been wrongly diagnosed as asthmatic and be receiving unnecessary treatment for the condition, the National Institute for Health and Care Excellence (NICE) has warned. 

The watchdog said that over 4.1 million people in the UK are currently receiving treatment for asthma, but studies show that almost a third (30%) of adults with the condition do not have clear evidence of asthma. 

NICE added that there is currently no ‘gold standard’ test to diagnose asthma and in current practice healthcare professionals mainly check for signs and symptoms. 

In order to tackle potential misdiagnosis, NICE has issued a draft guideline for England, published for consultation before final approval, to set out the most effective way to diagnose asthma. 

The first test should be carried out using a spirometer, a machine which measures how much and how fast you breathe out. However, the guidelines suggest that further breath tests should be carried out depending on the results from spirometry and the patient’s age. 

It has also been recommended that for adults and young people over five years, tests include checking for levels of nitric oxide, a gas which is found in larger volumes in people with asthma (FeNO test3), and whether standard medicines which widen the airways of the lung are of benefit (BDR test4). 

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.” 

The draft guideline also recommends that healthcare professionals should ask employed people how their symptoms are affected by work to check if they may have ‘occupational asthma’. This is because around one in 10 adults with asthma develops the condition because they are exposed to certain substances, such as chemicals or dust, in their workplace. 

Kay Boycott, chief executive at Asthma UK, welcomed the NICE guideline and hopes that it 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,” she said. 

“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.” 

The draft guidance for ‘diagnosis and monitoring of asthma in adults, children and young people’ is available, here

Tell us what you think – have your say below or email


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