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Suggesting That GPs Don't Take the Diagnosis of Asthma Seriously Is Insulting

14/04/2016 17:16

The health of our children should not be trivialised, and neither should serious conditions like asthma, so I was deeply disappointed to read in the news that doctors are giving out inhalers 'like fashion accessories'.

The claim, off the back of an editorial published in the Archives of Disease in Childhood, is based on an Australian study that looks at one sub-group of children presenting with cough alone. But whilst this study is useful in the grand scheme of understanding asthma and informing clinical guidelines, it is just one study and its findings should not be taken as gospel.

Asthma affects as many as one in 11 children, and when not controlled, symptoms do include a cough, but also wheeze, breathlessness and disturbed sleep.

All in all, it is an extremely distressing condition for the children affected, and their families and it is essential that an accurate diagnosis of asthma is made in children, to avoid unnecessary treatment, but also to identify children who might be suffering with untreated asthma.

But to suggest that GPs - and other healthcare professionals - do not take the identification and management of this disease seriously, is inappropriate and insulting.

As a practising GP myself, I can assure you that any decisions GPs make to prescribe inhalers - or any other medications for asthma - will always be made in the best interests of the patient in front of them.

Family doctors are highly trained to identify symptoms, prescribe appropriately and monitor treatment to help patients of all ages manage their condition. With that in mind I'd like to reassure our young patients - and their parents - who might have been panicked by the sensationalist headlines, that the majority of asthma cases are managed well with the right treatment and appropriate monitoring.

The diagnosis and treatment of asthma is an incredibly difficult task in primary care, as some common symptoms are similar to those of other illnesses, and there is no black and white test to differentiate whether someone is suffering from asthma, or not.

But still, we wouldn't prescribe medication to a child unless we really thought it necessary - but an initial diagnosis of asthma isn't a diagnosis for life.

We might initially recommend the blue 'puffer' inhaler if a patient presents with an irritating cough that has persisted for several weeks, and then monitor the condition, see how it changes and adjust the diagnosis and treatment accordingly.

This is made possible due to the unique relationships that GP teams have with their patients - and it is particularly important with long-term conditions such as asthma. It allows us to work with the parents of children to develop a management plan, to ensure that the patient is not taking something unnecessarily over a prolonged period of time.

Beyond the headline - which even one of the authors himself has since admitted was 'facetious' - the authors of the editorial make a valid point; taking an inhaler when it isn't necessary isn't good for your health and overdiagnosis is an issue that GPs - indeed doctors across the health service - should be mindful about.

But underdiagnosis is a serious issue too, and it remains the case that asthma is still underdiagnosed and undertreated, which as the National Review of Asthma Deaths found two years ago, has tragic consequences.

In fact the paper doesn't actually say that asthma is overdiagnosed; it advocates that doctors use objective tests, wherever possible.

And here lies the biggest problem for GPs. There is no single test that can definitively diagnose the disease in primary care. Some useful tests, such as the FeNo test that is recommended in new NICE guidelines are available for GPs for children over five years of age, but access is limited as these are very costly.

We need investment in general practice so that surgeries can afford to buy the relevant equipment - and train staff in how to use them - in the best interests of our patients; this would be a huge and important step in supporting GPs and our teams to diagnose asthma appropriately and confidently, and keep our patients safe and sound.

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