Aaron SD, et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017. PMID 28114551

One-paragraph summary

Investigators recruited 701 Canadian adults with physician-diagnosed asthma established within five years. Participants underwent symptom/home peak-flow monitoring, spirometry and serial bronchial challenge; daily medication was tapered under a structured protocol when safe. Of 613 conclusively evaluated participants, current asthma was ruled out in 203 (33.1%, 95% CI 29.4–36.8). At 12 months, 181 (29.5%, 25.9–33.1) still had no clinical or laboratory evidence of asthma. Twelve participants (2.0%) had serious cardiorespiratory diagnoses previously attributed to asthma.

Key findings

• One third of evaluable recent community diagnoses were not confirmed under a rigorous taper-and-test protocol.
• Objective airflow testing at initial diagnosis had been less common when asthma was later ruled out: 43.8% versus 55.6%, absolute difference 11.8% (95% CI 2.1–21.5).
• The finding includes both initial misdiagnosis and possible spontaneous remission; the study cannot assign every case to one cause.

Limitations

• People requiring long-term oral corticosteroids or unable to undergo spirometry were excluded.
• A negative protocol does not prove asthma never existed.
• Medication withdrawal occurred with close study supervision and must not be copied without clinical safeguards.
• Canadian access and referral conditions may not generalize globally.

Why it matters

This study makes objective confirmation a safety intervention, not a bureaucratic preference. Unverified asthma exposes people to unnecessary medication and can delay serious alternative diagnoses; indiscriminate withdrawal can also be dangerous. The correct response is structured reevaluation.

Cited by wiki pages

• diagnosis and objective testing