The criteria physicians use to diagnose asthma are not uniform and often do not follow official guidelines, according to study results published in the Annals of the American Thoracic Society. These results mirror previous findings. 

Researchers surveyed pediatric physicians to study the various methods used to diagnose asthma. This included influence toward diagnosis based on physician specialty and the extent of diagnostic variations. Overall, 205 pediatric pulmonologists (142 from the United States and 63 from 24 other countries) and 111 pediatric nonpulmonologists responded to the online survey. Of those contacted, approximately 15% of pediatric pulmonologists and >30% of nonpulmonologists responded to the survey, which included a list of clinical criteria and a list of diagnostic tests.

The physicians were instructed to choose the elements they considered appropriate to diagnose asthma. Pulmonologists were recruited from the online Ped-Lung forum for pediatric pulmonologists, and nonpulmonologists were recruited from the faculty and staff at Children’s National Medical Center in Washington, DC. All responses were anonymous. 

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The pediatric pulmonologists chose symptom resolution following treatment with bronchodilators as the key clinical criterion for asthma diagnosis most often at a rate of 85%. The second most common choice among pediatric pulmonologists was symptoms on exertion at a rate of 55%, and the third most common was recurrent or persistent cough without infection at a rate of 35%. The nonpulmonologists chose symptoms on exertion at a rate of 76%, resolution of symptoms following treatment with bronchodilators at a rate of 74%, and recurrent or persistent cough without infection at a rate of 38%. 

For diagnostic tests, 91% of pulmonologists chose spirometry prior to and following bronchodilators as a diagnostic aid. In contrast, 64% of nonpulmonologists did not use any tests. There were no response differences between pulmonologists in the United States and those in other countries.

Study limitations included a focus on pediatricians and nonpulmonologists being recruited from a single institution.

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“Our survey revealed significant discrepancies between the responders’ practices and the official asthma guidelines,” the researchers concluded. “[T]he term ‘physician diagnosed asthma’ should be either avoided or, when used (especially in research), it should be accompanied by the specific criteria on which the diagnosis was based.”


Koumbourlis AC, Perez GF. Heterogeneity in the diagnostic criteria physicians use in pediatric asthma [published online November 26, 2018]. Ann Am Thorac Soc. doi:10.1513/AnnalsATS.201807-457RL