Martin Luther likened human reason to a drunken man on horseback, alternately falling off to the left and then to the right.The same is true of diagnosing asthma; undoubtedly in the past, it was underdiagnosed, but have we gone too far in the opposite direction? The evidence is that we have; for example, in an Australian paper, in which more than 100 children with a chronic cough were investigated intensively, including with bronchoscopy (which we do not recommend as a routine diagnostic test), half were given a diagnosis of asthma prior to investigation; the number actually thought to have asthma had dwindled to 5% at the end of testing.
Although cough-variant asthma exists, it is overdiagnosed; an isolated cough in the community is rarely, if even, due to asthma,and even in a tertiary center, atopic children with a cough only infrequently have eosinophilic inflammation. The key to…
