Asthma Diagnosis and Differential Diagnosis

  • Stephen A. Tilles
  • Harold S. Nelson


When a patient reports having dyspnea, cough, or wheezing, most clinicians appropriately consider asthma as a possible diagnosis. However, despite awareness in recent years of the increased prevalence of asthma, there is considerable epidemiologic evidence that asthma is underdiagnosed, particularly in children [1], adolescents [2], and elderly individuals [3,4], Conversely, there are a variety of “masqueraders” that are often incorrectly diagnosed and inappropriately treated as asthma. In other patients, asthma symptoms fail to respond to treatment because of the presence of one or more additional diagnoses that complicate their asthma. When symptoms fail to respond to the usual asthma therapies, patients are often treated with increasing doses of systemic corticosteroids, resulting in unnecessary and sometimes permanent side effects. The potential magnitude of this problem is illustrated by the vocal cord dysfunction (VCD) experience at the National Jewish Medical and Research Center in Denver. Of all patients referred with “refractory asthma,” nearly 10% were instead found to have a syndrome called VCD [5]. The largest published VCD case series from the same institution reported inappropriate prior treatment of such patients with prednisone averaging nearly 30 mg/d for more than 4 years [6••].


Chronic Obstructive Pulmonary Disease Allergic Rhinitis Severe Asthma Fluticasone Propionate Peak Expiratory Flow 
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© Springer Science+Business Media New York 2003

Authors and Affiliations

  • Stephen A. Tilles
  • Harold S. Nelson

There are no affiliations available

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