PMID- 28114551
OWN - NLM
STAT- MEDLINE
DCOM- 20170213
LR  - 20180416
IS  - 1538-3598 (Electronic)
IS  - 0098-7484 (Linking)
VI  - 317
IP  - 3
DP  - 2017 Jan 17
TI  - Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma.
PG  - 269-279
LID - 10.1001/jama.2016.19627 [doi]
AB  - Importance: Although asthma is a chronic disease, the expected rate of
      spontaneous remissions of adult asthma and the stability of diagnosis are
      unknown. Objective: To determine whether a diagnosis of current asthma could be
      ruled out and asthma medications safely stopped in randomly selected adults with 
      physician-diagnosed asthma. Design, Setting, and Participants: A prospective,
      multicenter cohort study was conducted in 10 Canadian cities from January 2012 to
      February 2016. Random digit dialing was used to recruit adult participants who
      reported a history of physician-diagnosed asthma established within the past 5
      years. Participants using long-term oral steroids and participants unable to be
      tested using spirometry were excluded. Information from the diagnosing physician 
      was obtained to determine how the diagnosis of asthma was originally made in the 
      community. Of 1026 potential participants who fulfilled eligibility criteria
      during telephone screening, 701 (68.3%) agreed to enter into the study. All
      participants were assessed with home peak flow and symptom monitoring,
      spirometry, and serial bronchial challenge tests, and those participants using
      daily asthma medications had their medications gradually tapered off over 4 study
      visits. Participants in whom a diagnosis of current asthma was ultimately ruled
      out were followed up clinically with repeated bronchial challenge tests over 1
      year. Exposure: Physician-diagnosed asthma established within the past 5 years.
      Main Outcomes and Measures: The primary outcome was the proportion of
      participants in whom a diagnosis of current asthma was ruled out, defined as
      participants who exhibited no evidence of acute worsening of asthma symptoms,
      reversible airflow obstruction, or bronchial hyperresponsiveness after having all
      asthma medications tapered off and after a study pulmonologist established an
      alternative diagnosis. Secondary outcomes included the proportion with asthma
      ruled out after 12 months and the proportion who underwent an appropriate initial
      diagnostic workup for asthma in the community. Results: Of 701 participants (mean
      [SD] age, 51 [16] years; 467 women [67%]), 613 completed the study and could be
      conclusively evaluated for a diagnosis of current asthma. Current asthma was
      ruled out in 203 of 613 study participants (33.1%; 95% CI, 29.4%-36.8%). Twelve
      participants (2.0%) were found to have serious cardiorespiratory conditions that 
      had been previously misdiagnosed as asthma in the community. After an additional 
      12 months of follow-up, 181 participants (29.5%; 95% CI, 25.9%-33.1%) continued
      to exhibit no clinical or laboratory evidence of asthma. Participants in whom
      current asthma was ruled out, compared with those in whom it was confirmed, were 
      less likely to have undergone testing for airflow limitation in the community at 
      the time of initial diagnosis (43.8% vs 55.6%, respectively; absolute difference,
      11.8%; 95% CI, 2.1%-21.5%). Conclusions and Relevance: Among adults with
      physician-diagnosed asthma, a current diagnosis of asthma could not be
      established in 33.1% who were not using daily asthma medications or had
      medications weaned. In patients such as these, reassessing the asthma diagnosis
      may be warranted.
FAU - Aaron, Shawn D
AU  - Aaron SD
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - Vandemheen, Katherine L
AU  - Vandemheen KL
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - FitzGerald, J Mark
AU  - FitzGerald JM
AD  - Department of Medicine, University of British Columbia, Vancouver, British
      Columbia, Canada.
FAU - Ainslie, Martha
AU  - Ainslie M
AD  - Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada.
FAU - Gupta, Samir
AU  - Gupta S
AD  - Li Ka Shing Knowledge Institute of St Michael's Hospital, Department of Medicine,
      University of Toronto, Toronto, Ontario, Canada.
FAU - Lemiere, Catherine
AU  - Lemiere C
AD  - Department of Medicine, Universite de Montreal, Montreal, Quebec, Canada.
FAU - Field, Stephen K
AU  - Field SK
AD  - Department of Medicine, University of Calgary, Calgary, Alberta, Canada.
FAU - McIvor, R Andrew
AU  - McIvor RA
AD  - Firestone Institute for Respiratory Health, McMaster University, Hamilton,
      Ontario, Canada.
FAU - Hernandez, Paul
AU  - Hernandez P
AD  - Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
FAU - Mayers, Irvin
AU  - Mayers I
AD  - Department of Medicine, University of Alberta, Edmonton, Alberta, Canada.
FAU - Mulpuru, Sunita
AU  - Mulpuru S
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - Alvarez, Gonzalo G
AU  - Alvarez GG
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - Pakhale, Smita
AU  - Pakhale S
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - Mallick, Ranjeeta
AU  - Mallick R
AD  - Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario,
      Canada.
FAU - Boulet, Louis-Philippe
AU  - Boulet LP
AD  - Centre de Recherche, Hopital Laval, Universite Laval, Quebec, Quebec, Canada.
CN  - Canadian Respiratory Research Network
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - JAMA
JT  - JAMA
JID - 7501160
RN  - 0 (Anti-Asthmatic Agents)
SB  - AIM
SB  - IM
CIN - JAMA. 2017 Jan 17;317(3):262-263. PMID: 28114530
CIN - JAMA. 2017 May 2;317(17 ):1801-1802. PMID: 28464136
CIN - JAMA. 2017 May 2;317(17 ):1801. PMID: 28464135
CIN - Am J Respir Crit Care Med. 2018 Apr 15;197(8):1065-1067. PMID: 29494210
MH  - Adult
MH  - Anti-Asthmatic Agents/*therapeutic use
MH  - Asthma/*diagnosis/*drug therapy/epidemiology
MH  - Bronchial Provocation Tests
MH  - Canada/epidemiology
MH  - Chronic Disease
MH  - Cohort Studies
MH  - Diagnosis, Differential
MH  - Female
MH  - Heart Diseases/diagnosis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Prospective Studies
MH  - Respiration Disorders/diagnosis
MH  - Spirometry
MH  - *Withholding Treatment
EDAT- 2017/01/24 06:00
MHDA- 2017/02/14 06:00
CRDT- 2017/01/24 06:00
PHST- 2017/01/24 06:00 [entrez]
PHST- 2017/01/24 06:00 [pubmed]
PHST- 2017/02/14 06:00 [medline]
AID - 2598265 [pii]
AID - 10.1001/jama.2016.19627 [doi]
PST - ppublish
SO  - JAMA. 2017 Jan 17;317(3):269-279. doi: 10.1001/jama.2016.19627.