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Do physicians need objective measurements to diagnose asthma?

E Adelroth, F E Hargreave, E H Ramsdale

    The American Review of Respiratory Disease
    |October 1, 1986
    PubMed
    Summary
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    Disagreement between clinical asthma diagnosis and methacholine airway responsiveness tests is common (39%). Objective tests like methacholine inhalation are valuable for diagnosing asthma when spirometry is normal.

    Area of Science:

    • Pulmonology
    • Clinical Medicine
    • Diagnostic Testing

    Background:

    • Asthma diagnosis often relies on clinical assessment and spirometry.
    • Normal spirometry does not always exclude asthma.
    • The utility of objective airway responsiveness testing in such cases is not well-defined.

    Purpose of the Study:

    • To determine the frequency of disagreement between clinical asthma diagnosis and methacholine airway responsiveness testing.
    • To assess the clinical utility of methacholine inhalation tests in patients with asthma-like symptoms and normal spirometry.

    Main Methods:

    • Prospective examination of 51 new adult patients with asthma-like symptoms and normal spirometry.
    • Comparison of clinician's asthma diagnosis with methacholine inhalation test results.

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    Main Results:

    • Disagreement occurred in 39% of patients (20 out of 51).
    • 13 patients had a clinical asthma diagnosis but normal methacholine responsiveness.
    • 7 patients showed unexpected increased methacholine responsiveness despite normal spirometry.

    Conclusions:

    • Methacholine inhalation testing is a clinically useful objective measure for asthma diagnosis when spirometry is normal.
    • Normal methacholine test results in symptomatic patients warrant further investigation for alternative diagnoses or underlying airway hyperresponsiveness.