Conditions that appear as Asthma but are NOT

“All that wheezes is not asthma," said a wise Dr. Chevalier Jackson once. A 2015 study conducted by NHS warned that about one third of the diagnosed asthmatics may not actually have the disease. A study in the British Journal of General Practice suggested that of about one million children diagnosed with asthma in UK, half the million may not have the disease.A more recent 2017 study in Journal of the American Medical Association also concluded that a third of the diagnosed asthmatics do not have the condition. So, where is the diagnosis going wrong?
We talked to two doctors, Dr. R K Mani, CEO, Nayati Healthcare and Chairman, Pulmonology and Critical Care, and Dr Manav Manchanda, senior Pulmonologist, Asian Institute of Medical Sciences. They shared with us the conditions, which often get misdiagnosed and appear as asthma.
THE CONDITIONS THAT GUISE AS ASTHMA
Sinusitis
Both Dr Mani and Dr Manchanda said that sinus is one condition that can easily guise as asthma. “In my own practice I often see cough due to sinusitis being mistaken for asthma,” said Dr Mani. The confusion begins due to overlapping of symptoms between these two conditions.
Gastric Reflux Disease
The symptoms of a gastric reflux also correspond with the symptoms of asthma. Dr Manav said thta GERD often causes pain in chest, upper abdomen, coughing and sore throat, all this also being common in asthma.
Heart Problems
Heart disease can prove fatal if it is not diagnosed in time. It is really important to demarcate asthma and a heart problem, the common symptom for both of them being breathlessness. Dr Manav says that an ECG test is vital to diagnose a heart disease before it is confused with asthma.
Respiratory Infection
Respiratory infections are very common viral infections that may affect the nose, throat and the airways. It may cause an inflamed nose that causes difficulty in breathing and cough. A substandard diagnosis can make it appear as asthma.
Lung Cancer
The symptoms of lung cancer match the most with asthma. They can both be characterized with a chronic cough, shortness of breath, wheezing and chest discomfort, says Dr Manav. Both these conditions are critical and their possibility should only be ruled out after a proper diagnosis.
Pulmonary Edema
Dr Mani said that he has come across patients who were dealing with a case of water in lungs as a case of asthma. Pulmonary Edema also has many symptoms that correspond with asthma, such as breathlessness, wheezing, coughing, and chest discomfort.
WHERE DO WE LACK?
Doctors are over-diagnosing the condition and inhalers are dispensed without a good reason. The diagnostic facilities in India are underdeveloped and Dr Manav said that many a times Lung Function Test, which is necessary for asthma’s diagnosis, is not performed. This is because the machinery required for the test is not available in clinics but only in hospitals.
“Diagnosis of asthma should always be verified by a chest X-ray and spirometry in which breathing is tested. Accurate diagnosis is a must to avoid side effects, cost of unnecessary medication and to zero down the right treatment," said Dr Mani. But in India, the situation is slightly more complex than the West. There are cases when a lot of patients go undiagnosed, majorly in rural and less developed regions. While urban India may have to battle misdiagnosis of asthma, Indian rural regions have their own battles to fight.