For some time now, I have felt that the surge in the number of asthma diagnoses may have been deceptive. As Dr Thomas Brown reports on the AsthmaUK blog, it’s very much an umbrella term for a whole group of different conditions that present with similar symptoms. Breathlessness, chest tightness, wheezing, and coughing are the most common. This has no doubt helped those pharmaceutical companies which provide relieving inhalers while not helping true sufferers. Dr Brown goes on:
we call this ‘asthma’ when these symptoms are accompanied by variable narrowing and/or inflammation of the airway tubes which we can measure using breathing tests. However, the symptoms, airway narrowing, and inflammation can vary a lot over time, and sometimes this means tests can be normal even though a person has ‘asthma’.
There can be a big difference between the types of tests somebody might have access to in different parts of the country, particularly in primary care. And some of these tests are difficult to do well. Spirometry, which is one of the blowing tests we use is a really good example. To do that well is actually very difficult, but not just technically very difficult, it can be really uncomfortable and distressing for our patients.
The other point is that in people who have asthma, they might be completely well at the time that they have their test. So it may be that their tests are all normal, but they have symptoms at other times. And so, what we’ve ended up with is this acceptance that it’s okay to go with either a trial of treatment or a ‘wait and see’ option, but that leaves a lot of uncertainty for patients. It can also mean people getting the wrong treatment or delays in them getting the right one.
This can mean that patients are presenting to us with a crisis such as an acute asthma attack in order for us to make the diagnosis. We know that we have effective treatments for a lot of these patients that we could start if we could have made the diagnosis before the crisis point.
The other problem is that there’s a lot of overlap with the symptoms of different lung conditions, which can make it difficult to make the right diagnosis. This means that some people may receive an incorrect diagnosis and therefore be put on the wrong treatment. What we’ve also learned, particularly over the last 10 or 20 years, is that there are different types of asthma and that’s very important because the different types of asthma may require very different treatments.
There’s no doubt it’s absolutely vital that we make the right diagnosis early and that people are aware of the condition they have because the treatments we have are effective. It’s about getting the right diagnosis and the right treatment as early as we can.
Research supported by Asthma UK and the British Lung Foundation looking at a new breathing test Our research recognises the difficulty of identifying asthma. At the moment the diagnosis of asthma is a bit like a jigsaw. We bring together different pieces of information, including symptoms, results from the blowing tests and sometimes we look for inflammation, although that test isn’t always widely available, particularly in a GP setting.
In our study, we’re looking at a new breathing test that might be useful in identifying whether somebody has asthma. This test could be used alongside existing tests or might have value in its own right as a stand-alone test.
The device we’re testing is a “point of care” test, which means that it’s something that you do in the GP surgery. It’s a breathing test that takes one to three minutes for a patient to do, but importantly you don’t have to do a forced breath as you do in spirometry. You do gentle breathing in and out, and the device measures several different things over that time period, and it forms then what we’re calling a ‘breath print’.
We want to see if this ‘breath print’, alongside the other information that we have in terms of established tests for asthma, can enhance diagnosis. We also want to see if this test can help us to identify specific characteristics of that person’s asthma that might help us tailor an individual person’s treatment so that it’s optimal. And this new test might also help us diagnose other lung conditions.
We want people with asthma to have access to the right treatment as soon as possible, and also make sure that people who don’t have asthma are not then taking treatments they don’t need, which can be detrimental in their own right. We hope that this new test will help make problems with asthma diagnosis a thing of the past.