Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma | Asthma | JAMA | JAMA Network
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Original Investigation
January 17, 2017

Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma

Author Affiliations
  • 1Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
  • 2Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
  • 3Department of Medicine, University of Manitoba, Winnipeg, Manitoba, Canada
  • 4Li Ka Shing Knowledge Institute of St Michael’s Hospital, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
  • 5Department of Medicine, Université de Montréal, Montréal, Québec, Canada
  • 6Department of Medicine, University of Calgary, Calgary, Alberta, Canada
  • 7Firestone Institute for Respiratory Health, McMaster University, Hamilton, Ontario, Canada
  • 8Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  • 9Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
  • 10Centre de Recherche, Hopital Laval, Université Laval, Québec, Québec, Canada
JAMA. 2017;317(3):269-279. doi:10.1001/jama.2016.19627
Key Points

Question  Can current asthma be ruled out and can asthma medications be safely stopped in some adult patients with physician-diagnosed asthma?

Findings  In this multicenter cohort study that enrolled 701 randomly selected adults with physician-diagnosed asthma, current asthma was excluded in 33% of the 613 participants who completed the study.

Meaning  Among some adult patients with physician-diagnosed asthma, reassessing that diagnosis may be warranted.


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.