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Asthma is a relatively common disease, with estimates by the World Health Organization that it affects about one person out of twenty. As a physician specializing in the treatment of asthma, I have always felt these numbers were too high. Essentially, all that wheezes is not asthma. A new analysis of patients with physican diagnosed asthma confirms that impression. As reported in DocCheck News, a lung specialist in Ottawa Canada, Dr. Shawn Aaron, recently tried to confirm an asthma diagnosis in almost 700 stable adult patients were taking asthma medications every day. These medications included inhaled steroids, bronchodilators and monteleukast. Extensive lung function tests were performed on the “asthmatics” while they were taking their medications. If their lung function was normal, they were then asked to stop their medications. Subsequently, they underwent a breathing test that triggers and confirms the diagnosis of asthma by inhaling a substance called methacholine. This chemical is very irritating to true asthmatics and provokes airway obstruction to airflow and inducing wheezing. The final outcome was one third of “asthmatics” had no asthma off medications, could not be provoked into asthma with methacholine and were still asthma free after one year off their medications. Dr. Aaron surmised these patients were either in remission, or misdiagnosed. Common alternative diagnoses that mimic asthma included gastroesophageal reflux( heartburn), nasal allergies, blood clots in the lung, heart failure and chronic lung scarring and high blood pressure in the lungs. Lung function testing and methacholine challenge were the critical pieces missing for most people who were misdiagnosed with asthma. Similar findings occurred in a Dutch study of children. Although the study was not as rigorous as the previous one, the diagnosis was not supported by symptoms in one out of four patients. Lung function tests were only performed in fifteen per cent of the children, most likely because of the technical issues involved in coaxing children to perform the tests correctly. Both studies conclude by stating all people suspected of having asthma should have lung functions tests. One reason these tests may be normal is that asthma is an intermittent disease. Misdiagnosis is common when physicians fail to consider other diseases. A lung provocation test is the most sensitive test to diagnose asthma but most time consuming to perform. A new test but easier to perform than the methacholine challenge takes is now available. It requires about six seconds to perform and measures an exhaled gas from the lungs called nitric oxide. This office based test is very sensitive and specific for diagnosing asthma, even when lung function tests are normal and there are no symptoms. We offer both types of tests in our office. If you have been diagnosed with asthma there is a one in three chance you have the wrong diagnosis.