Overdiagnosis of asthma in children in primary care: a retrospective analysis
Overdiagnosis of asthma in children in primary care: a retrospective analysis
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DOI：
10.3399/bjgp16x683965
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发表时间：
2016-03-01
影响因子：
5.9
通讯作者：
Verheij, Theo
中科院分区：
文献类型：
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作者：
Looijmans-Van den Akker, Ingrid;van Luijn, Karen;Verheij, Theo
背景哮喘是儿童最常见的慢性病之一。根据指南，6岁儿童应通过肺功能测试确诊为哮喘。先前的研究表明，儿童哮喘可能被过度诊断。目的评价经全科医生诊断为哮喘或接受哮喘治疗的儿童哮喘确诊和未确诊的程度和特点。设计和设置对荷兰乌得勒支4个学术初级保健中心的资料进行回顾分析。方法对确诊或治疗的6~18岁儿童的常规护理登记资料进行分析。结果经肺功能测定确诊的哮喘儿童中，仅有16.1%(n=105)确诊为哮喘。而在23.2%(n=151)的儿童中，这些体征和症状确实引起了可疑的哮喘，但儿童应该接受进一步的肺功能测试。在超过一半(53.5%，n=349)的儿童中，这些体征和症状使哮喘不太可能发生，因此他们很可能被误诊了。其余的7.2%(n=47)可能被正确归类为没有哮喘。未做肺功能检查的儿童哮喘分类的主要原因是呼吸困难(31.9%，n=174)、咳嗽(26.0%，n=142)和喘息(10.4%，n=57)。结论儿童哮喘在初级保健中普遍存在误诊现象，导致不必要的治疗，疾病负担，影响生活质量。然而，只有一小部分儿童的哮喘诊断是通过肺功能测试确认的。
BackgroundAsthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged >6 years. Previous studies indicate that asthma in children is probably overdiagnosed. However, the extent has not previously been assessed.AimTo assess the extent and characteristics of confirmed and unconfirmed diagnoses of asthma in children who were diagnosed by their GP as having asthma or who were treated as having asthma.Design and settingRetrospective analysis in four academic primary healthcare centres in Utrecht, the Netherlands.MethodRoutine care registration data of children aged 6-18 years who received a diagnosis of asthma or were treated as having asthma were analysed.ResultsIn only 16.1% (n = 105) of the children diagnosed with asthma was the diagnosis confirmed with spirometry, whereas in 23.2% (n = 151) the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests. In more one-half (53.5%, n = 349) of the children the signs and symptoms made asthma unlikely and thus they were most likely overdiagnosed. The remaining 7.2% (n = 47) were probably correctly classified as not having asthma. The main reasons for classifying asthma without children undergoing further lung function tests were dyspnoea (31.9%, n = 174), cough (26.0%, n = 142), and wheezing (10.4%, n = 57).ConclusionOverdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.