title: Diagnosis of asthma - new theories.
abstract: BACKGROUND
  Recent studies have shown a remarkably high frequency of poorly controlled asthma. Several reasons for this treatment failure have been discussed, however, the basic question of whether the diagnosis is always correct has not been considered. Follow-up studies have shown that in many patients asthma cannot be verified despite ongoing symptoms. Mechanisms other than bronchial obstruction may therefore be responsible. The current definition of asthma may also include symptoms that are related to mechanisms other than bronchial obstruction, the clinical hallmark of asthma.
  
  
  OBJECTIVE
  Based on a review of the four cornerstones of asthma - inflammation, hyperresponsiveness, bronchial obstruction and symptoms - the aim was to present some new aspects and suggestions related to the diagnosis of adult non-allergic asthma.
  
  
  CONCLUSIONS
  Recent studies have indicated that "classic" asthma may sometimes be confused with asthma-like disorders such as airway sensory hyperreactivity, small airways disease, dysfunctional breathing, non-obstructive dyspnea, hyperventilation and vocal cord dysfunction. This confusion may be one explanation for the high proportion of misdiagnosis and treatment failure. The current diagnosis, focusing on bronchial obstruction, may be too "narrow". As there may be common mechanisms a broadening to include also non-obstructive disorders, forming an asthma syndrome, is suggested. Such broadening requires additional diagnostic steps, such as qualitative studies with analysis of reported symptoms, non-effort demanding methods for determining lung function, capsaicin test for revealing airway sensory hyperreactivity, careful evaluation of the therapeutic as well as diagnostic effect of corticosteroids and testing of suggested theories.
authors.affiliation: a Institute of Medicine, Sahlgrenska Academy, University of Göteborg , Göthenburg , Sweden.
authors.forename: Olle
authors.initials: O
authors.lastname: Löwhagen
mesh_terms: D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000402:Airway Obstruction / Q000503:physiopathology; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D001250:Asthma, Exercise-Induced / Q000503:physiopathology; D016535:Bronchial Hyperreactivity / Q000503:physiopathology; D001985:Bronchial Provocation Tests; D006801:Humans; D007249:Inflammation / Q000276:immunology
chemical_list: D000305:Adrenal Cortex Hormones
keywords: Diagnostics; epidemiology; exercise induced; management/control; mechanisms