Post-publication Peer Review (P3R) is an online forum for ongoingreview peer review. To submit a P3R please go to the article you wish to respond to and click on the link that reads "P3Rs: Submit a Response." Submission of P3Rs are open to all health care professionals and experts in related fields.

Post-publication Peer Reviews to:

REVIEW ARTICLES:
Miles Weinberger and Mutasim Abu-Hasan
Pseudo-asthma: When Cough, Wheezing, and Dyspnea Are Not Asthma
Pediatrics 2007; 120: 855-864 [Abstract] [Full text] [PDF]
*P3Rs: Submit a response to this article

P3Rs published:

[Read P3R] The overdiagnosis of pediatric asthma.
Michael Seear, David Wensley, Amy Hoepker   (5 October 2007)

The overdiagnosis of pediatric asthma. 5 October 2007
Top
Michael Seear,
Pediatric respirology/intensive care
Children's Hospital, Vancouver, Canada,
David Wensley, Amy Hoepker

Send letter to journal:
Re: The overdiagnosis of pediatric asthma.

mseear{at}cw.bc.ca Michael Seear, et al.

Sir:

In their timely and comprehensive review of the dangers of overdiagnosing respiratory complaints in children, Weinberger et al(1), kindly mentioned one of our two earlier publications on the subject of diagnostic error in pediatric asthma(2),(3). At a time when symptom-based diagnoses such as asthma, ADHD and depression are claimed to be increasingly common amongst children, we believe the points the authors raise about potential diagnostic error are well worth emphasising.

Although there are a number of ancillary tests available, asthma remains a diagnosis based largely on self reported symptoms. Establishing the significance of these reports can be difficult, even when given first hand by an adult. Once a child's complaints of difficulty in breathing are interpreted by a parent, the chance of diagnostic error increases. National asthma studies based only on retrospective questionnaires about a child's wheeze or cough during the past year, are also open to error. Despite these problems, the asthma literature contains surprisingly little research into diagnostic accuracy. At time of writing, a Medline search on the terms asthma/children produced 31,213 results. A search on asthma/children/diagnostic accuracy produced 19 (only 3 of which had any relevance).

The steady secular trend of improved health over the last 100 years has produced a generation of children, in developed countries, who are healthier, larger and probably even smarter than at any time in history. Claims of disease epidemics amongst this cohort (particularly those lacking a dependable diagnostic test) should be treated with some caution. If it doesn't seem likely that large numbers of healthy children require regular treatment with inhalers then it seems sensible to question the criteria upon which those treatments are based.

There is a truly urgent need for a more critical attitude towards symptom based diagnoses throughout the broad field of pediatric medicine. We hope that the work done in this area by Weinberger and our own group, will stimulate much needed research into the reliability of pediatric diagnoses based mainly on reported symptoms.

1. Weinberger M, Abu-Hasan M. Pseudo-asthma: when cough, wheezing and dyspnea are not asthma. Pediatrics 2007;120:855. 2. Seear M, Wensley D, West N. How accurate is the diagnosis of exercise induced asthma among Vancouver schoolchildren? Arch Dis Child 2005;90:898. 3. Seear M, Wensley D. Chronic cough and wheeze in childen: do they all have asthma? Eur Resp J 1997;10:342.

Conflict of Interest:

None declared