Clinicians should be proactive in testing for asthma

BMJ 1999;318:258 ( 23 January )

Letters

Clinicians should be proactive in testing for asthma

The first 150 words of the full text of this article appear below.

EDITOR $---$ Britton and Lewis adopt a nihilistic position in saying that tests for asthma are of little value and that diagnosisshould be based on clinical criteria.¹ The symptoms of asthmaare non-specific, which is why so many of the patients that wesee in our clinics with a diagnosis of asthma turn out not tohave the disease and are being treatedinappropriately.

Asthma is a well defined disease characterised by variable airflow obstruction, airway hyperresponsiveness, and eosinophilicmucosal inflammation which is caused, in most cases, by an aberrantimmune response to inhaled allergens.² We would therefore takethe opposite position to Britton and Lewis and say that cliniciansshould be much more proactive in supporting a clinical suspicionof asthma with objective testing. We believe this should routinelyinclude formal reversibility studies (home peak flow readingsare insensitive, non-specific, and have limited value in makinga diagnosis ³ ⁴ . . . [Full text of this article]