Welcome to Asthma Neverland

Asthma is a multifactorial disease with heterogeneous clinical and pathophysiological phenotypes. Classical symptoms of asthma are wheeze, cough and breathlessness, and occasionally chest tightness. These symptoms are common to many respiratory and non-respiratory conditions, and misdiagnosis of asthma is frequent. There is no definitive test for the diagnosis of asthma, but a combination of a suggestive medical history, physical examination, lung function tests, and additional investigations will maximize the chances of making a correct diagnosis. Despite clear statements in international asthma guidelines, there are many gaps when performing diagnostic steps in current medical practice. An incomplete medical history, poor attention to the nature of respiratory sounds, failure to carry out objective tests, and inadequate estimation of the response to anti-asthma therapy are the main factors responsible for misdiagnosis of asthma. The use of wrong and potentially dangerous therapies, and high consumption of healthcare resources are the inevitable consequences of misdiagnosis. The main alternative diagnoses to asthma, clinical clues and objective tests useful for specific diagnoses are critically discussed.