title: Overdiagnosis of asthma in children in primary care: a retrospective analysis.
abstract: BACKGROUND
  Asthma is one of the most common chronic diseases in childhood. According to guidelines, a diagnosis of asthma should be confirmed using lung function testing in children aged >6 years. Previous studies indicate that asthma in children is probably overdiagnosed. However, the extent has not previously been assessed.
  
  
  OBJECTIVE
  To assess the extent and characteristics of confirmed and unconfirmed diagnoses of asthma in children who were diagnosed by their GP as having asthma or who were treated as having asthma.
  
  
  METHODS
  Retrospective analysis in four academic primary healthcare centres in Utrecht, the Netherlands.
  
  
  METHODS
  Routine care registration data of children aged 6-18 years who received a diagnosis of asthma or were treated as having asthma were analysed.
  
  
  RESULTS
  In only 16.1% (n = 105) of the children diagnosed with asthma was the diagnosis confirmed with spirometry, whereas in 23.2% (n = 151) the signs and symptoms did give rise to suspected asthma but the children should have undergone further lung function tests. In more one-half (53.5%, n = 349) of the children the signs and symptoms made asthma unlikely and thus they were most likely overdiagnosed. The remaining 7.2% (n = 47) were probably correctly classified as not having asthma. The main reasons for classifying asthma without children undergoing further lung function tests were dyspnoea (31.9%, n = 174), cough (26.0%, n = 142), and wheezing (10.4%, n = 57).
  
  
  CONCLUSIONS
  Overdiagnosis of childhood asthma is common in primary care, leading to unnecessary treatment, disease burden, and impact on quality of life. However, only in a small percentage of children is a diagnosis of asthma confirmed by lung function tests.
authors.affiliation: Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Looijmans-van den Akker
authors.affiliation: Leidsche Rijn Julius Health Care Centers, Utrecht, the Netherlands.
authors.forename: Karen
authors.initials: K
authors.lastname: van Luijn
authors.affiliation: Professor of general practice and GP, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Theo
authors.initials: T
authors.lastname: Verheij
mesh_terms: D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D000069342:Medical Overuse / Q000191:economics / Q000706:statistics & numerical data; D009426:Netherlands / Q000453:epidemiology; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000191:economics / Q000379:methods; D011788:Quality of Life; D012129:Respiratory Function Tests / Q000379:methods*; D012135:Respiratory Sounds; D012189:Retrospective Studies
chemical_list: D018927:Anti-Asthmatic Agents
keywords: asthma; children; diagnosis; guidelines; respiratory function tests; spirometry