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I need help (please read)

Just as an interesting update for anyone who still cares, I was talking to my ex today and she mentioned that she got herself a puffer for emergencies. Looks like I did leave an impression.
 
Just a mild word of support for tnt666. Whilst I can see how some of you believed he overstated his case, I read his post exactly how he later explained it. He was not criticising those with acute asthma and yet it was exactly those posters that hit back so aggressively at him as if he had diminished their suffering. That was not what he was saying! He was talking about exactly the sort of cases I've seen in the UK when an over-weight or otherwise unhealthy kid gets diagnosed with asthma because they get short of breath when made to exercise (usually triggered by PE in school). Genuine asthma appears to be on the increase (lots of theories as to why: better diagnosis, more pollutants etc) but (semi anecdotal mode on) there also seems a tendency to diagnose kids with asthma just for getting short of breath (my limited understanding would be that an asthma attack is a triggered, physical contraction of the airwaves that makes it difficult to draw breath not just becoming 'out of breath').

As to why GPs would do this, my own experience is that it is unlikely to be a drive from 'big pharma' and far more likely that they are succumbing to parental / customer pressure. My cousin is a GP and often bemoans the fact that she is losing patients to other GPs in her practice because they prescribe anti-biotics for viral infections whilst she refuses to do so. When she points out to the other GPs that they will do no good, and indeed will increase resistance to them, they respond 'I know, but it's what they want and it gets them out of the surgery'. The last time I spoke to her about asthma (this was a few years ago mind) she said much the same as tnt666. She was getting overweight kids in suffering from shortness of breath, telling them they just needed to lose weight and then finding out weeks later that they'd gone to a colleague, been diagnosed with asthma and now had the inhalers they were after and could be excused from PE*.

I guess the above is anecdotal but it's not like it's 'A bloke in a pub told me...'. I've also heard the same from other members of my family (I'm about the only one who isn't a doctor or nurse!).

*Which always makes me laugh as there are many top athletes who suffer from asthma - it does not mean you can't take exercise!
 
When I was younger, a girl near where I lived died from a severe asthma attack. She had never been diagnosed with asthma, but her mum said she "always had a bad cough" but it didn't seem to be anything serious/worth bothering the doctor with. In my view,no matter how mild your asthma is, you should always speak to a doctor and always have an inhaler in your possession, just in case. I had it quite bad as a kid, but it cleared up as an adult, and now I only get attacks when I come into contact with animals, or when I get a really bad cold. I still ALWAYS carry my inhaler with me.
 
 
Thank you for those links Professor Yaffle.

It is fairly clear that asthma is diagnosed more frequently in people who are obese, and that symptoms and medication use that is tied to symptoms are increased. What is interesting is that there seems to be an assumption that asthma is over-diagnosed in the obese. Yet the studies suggest that what may be happening is that asthma is under-diagnosed in those with normal weight. Obesity may simply represent an increased opportunity for case-finding.

Linda
 
fls said:
Thank you for those links Professor Yaffle.

It is fairly clear that asthma is diagnosed more frequently in people who are obese, and that symptoms and medication use that is tied to symptoms are increased. What is interesting is that there seems to be an assumption that asthma is over-diagnosed in the obese. Yet the studies suggest that what may be happening is that asthma is under-diagnosed in those with normal weight. Obesity may simply represent an increased opportunity for case-finding.

Linda
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I don't dispute any of that, I was merely pointing out that I knew of some cases where a child had been cleared of having asthma by one GP and then given an inhaler and had their asthma confirmed by another who admitted it was down to 'pester power' rather than because the first had mis-diagnosed. Thus providing some, admittedly slim, evidence for tnt666's assertion that it was being over diagnosed.

In turn, I was moved to do this because I felt people had over-reacted to his post, interpreting it as being dismissive of genuine and serious cases of asthma which (as he himself later explained) it was not - and neither is mine meant to be.

I have other anecdotal evidence such as: a former friend of mine (we just lost touch over the years) who freely admited that he was registered as asthmatic but couldn't remember ever having an attack. He loved getting the inhalers on the NHS though as he used to have a quick squirt before inhaling certain, smoking related herbs to get a 'better hit'.* His brother is also asthmatic and again does not remember having an attack but thinks he might have been registered asthmatic 'in case' he had the same problem as his elder brother.

Again, I am not diminishing what can be an extremely serious condition and I have nothing but sympathy for those who suffer from it, but I do have some sympathy for tnt666's assertion following my own experiences. Of course, these experiences form a very small sample and I am in no way claiming that such over-diagnosis is widespread as I do not have compelling evidence of that.

*Not being an indulger I have no idea if this was effective or merely psychosomatic.
 
Ethan Thane Athen said:
I don't dispute any of that,...
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That was the conclusion arrived at in at least one of the studies cited (the last one, I think).

...I was merely pointing out that I knew of some cases where a child had been cleared of having asthma by one GP and then given an inhaler and had their asthma confirmed by another who admitted it was down to 'pester power' rather than because the first had mis-diagnosed. Thus providing some, admittedly slim, evidence for tnt666's assertion that it was being over diagnosed.
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Individual examples can't really provide evidence one way or the other, simply because diagnosis can't ever be perfect. That is, even if a condition is very well diagnosed (the diagnosis mostly isn't missed and it's mostly not over-diagnosed), you will always be able to find examples of both over and under-diagnosis. External validity is critical (i.e. how representative are your samples) to this issue, and individual stories rarely have external validity.

In turn, I was moved to do this because I felt people had over-reacted to his post, interpreting it as being dismissive of genuine and serious cases of asthma which (as he himself later explained) it was not - and neither is mine meant to be.

I have other anecdotal evidence such as: a former friend of mine (we just lost touch over the years) who freely admited that he was registered as asthmatic but couldn't remember ever having an attack. He loved getting the inhalers on the NHS though as he used to have a quick squirt before inhaling certain, smoking related herbs to get a 'better hit'.* His brother is also asthmatic and again does not remember having an attack but thinks he might have been registered asthmatic 'in case' he had the same problem as his elder brother.

Again, I am not diminishing what can be an extremely serious condition and I have nothing but sympathy for those who suffer from it, but I do have some sympathy for tnt666's assertion following my own experiences. Of course, these experiences form a very small sample and I am in no way claiming that such over-diagnosis is widespread as I do not have compelling evidence of that.

*Not being an indulger I have no idea if this was effective or merely psychosomatic.
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It's relevant to know whether 'asthmatic, but doesn't remember having an asthma attack' identifies a group of people who are not at higher risk than the general population from serious morbidity or mortality from an acute asthma attack. That would make your complaint valid, I think.

Linda
 
fls said:
It's relevant to know whether 'asthmatic, but doesn't remember having an asthma attack' identifies a group of people who are not at higher risk than the general population from serious morbidity or mortality from an acute asthma attack. That would make your complaint valid, I think.

Linda
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It wasn't meant to be a complaint and I pretty much agree with what you say so I'm bowing out now...
 
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