A new study suggests that large numbers of asthma patients in Italy are still being under-diagnosed or misdiagnosed some 20 years after the dissemination of the Global Initiative for Asthma guidelines to healthcare professionals. The findings could bear out an endemic problem in asthma treatment with broader implications. The study, “Asthma under/misdiagnosis in primary care setting: an observational community-based study in Italy,” was published in the Clinical and Molecular Allergy journal.

Asthma is a common inflammatory disease affecting both children and adults, characterized by airway hyper-responsiveness, obstruction, and mucus overproduction and remodeling of the airway wall. Globally, this condition affects more than 300 million people and presents a wide range of symptoms, and can be particularly severe in younger patients. The standard therapies for asthma, such as inhaled corticosteroids, have many adverse side effects including hampered growth in children. Under-diagnosis or late diagnosis, which affect therapy initiation, might be crucial factors contributing to asthma morbidity.

The community-based study investigated the level of asthma under/misdiagnosis in a primary care setting by comparing physician diagnosis and the European Community Respiratory Health Survey (ECRHS) questionnaire results. The study population included patients treated with inhaled corticosteroids (ICS) for physician-diagnosed respiratory diseases other than asthma. This was a multi-center, observational cross-sectional study of 540 Italian General Practitioners (GPs).

The study included 2,090 adult patients with an average age of 54.9 years, of which 54.1% were females, diagnosed with a respiratory disease, who had received at least three prescriptions for inhaled corticosteroids during the previous 12 months (metered-dose inhaler [MDI], dry powder inhaler [DPI], or nebulizer). The participants visited their general practitioner for a standardized interview and answered the ECRHS questionnaire, whose questions are based on the Global Initiative’s classification of asthma severity.

Within this patient group, 991 had physician-diagnosed asthma, while 1,099 subjects received a diagnosis other than asthma (chronic obstructive pulmonary disease, chronic upper respiratory tract infections, etc.). Among those diagnosed with a condition or disease other than asthma, the ECRHS questionnaire suggested asthma in 365 subjects (33.2%).

The researchers concluded that the ECRHS questionnaire detected a significant proportion of potentially asthmatic individuals who needed to undergo a lung function evaluation to confirm the diagnosis. The also recommended continued educational efforts targeting GPs to improve asthma diagnosis and the start of adequate therapy.

Overall, disease under-diagnosis and misdiagnosis — with consequent inappropriate pharmacological therapy — is a continuing problem in asthma management. This problem is an important contributor to asthma morbidity and mortality, because early detection and proper treatment play a crucial role in improving the long-term prognosis of patients.