Overdiagnosis of asthma in obese and nonobese adults
Open accessAbstract
BACKGROUND: It is unclear whether asthma is overdiagnosed in developed countries, particularly among obese individuals, who may be more likely than nonobese people to experience dyspnea. METHODS: We conducted a longitudinal study involving nonobese (body mass index 20-25) and obese (body mass index >/= 30) individuals with asthma that had been diagnosed by a physician. Participants were recruited from 8 Canadian cities by means of random-digit dialing. A diagnosis of current asthma was excluded in those who did not have evidence of acute worsening of asthma symptoms, reversible airflow obstruction or bronchial hyperresponsiveness, despite being weaned off asthma medications. We stopped asthma medications in those in whom a diagnosis of asthma was excluded and assessed their clinical outcomes over 6 months. RESULTS: Of 540 individuals with physician-diagnosed asthma who participated in the study, 496 (242 obese and 254 nonobese) could be conclusively assessed for a diagnosis of asthma. Asthma was ultimately excluded in 31.8% (95% confidence interval [CI] 26.3%-37.9%) in the obese group and in 28.7% (95% CI 23.5%-34.6%) in the nonobese group. Overdiagnosis of asthma was no more likely to occur among obese individuals than among nonobese individuals (p = 0.46). Of those in whom asthma was excluded, 65.5% did not need to take asthma medication or seek health care services because of asthma symptoms during a 6-month follow-up period. INTERPRETATION: About one-third of obese and nonobese individuals with physician-diagnosed asthma did not have asthma when objectively assessed. This finding suggests that, in developed countries such as Canada, asthma is overdiagnosed.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The manifestations of BPD are readily misinterpreted by both patients and clinicians as those of asthma or similar obstructive and restrictive conditions.
“The manifestations of BPD are readily misinterpreted-by both patients and cliniciansas those of asthma or similar obstructive and restrictive conditions.”
From Physiotherapy assessment of breathing pattern disorder: a qualitative evaluation (2023) · cites this paper as [8]
The Interpretation section (page not supplied) reports that many participants diagnosed with asthma had no evidence of it, despite reporting dyspnea and wheezing. This supports the possibility that clinicians mistake respiratory symptoms for asthma. The paper does not identify those symptoms as manifestations of BPD or establish that patients misinterpret them as asthma or other obstructive or restrictive conditions. (LLM, conf=0.83)
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
The citation lists haven’t been fetched yet
References 32 · Cited by 400
Research works printed but not linked: 23
- Devenny A, Wassall H, Ninan T, et al. Respiratory symptoms and atopy in chil- dren in Aberdeen: questionaire studies of a defined school population repeated over 35 years. BMJ 2004;329:489-90.
- Chinn S. Asthma and obesity: Where are we now? Thorax 2003;58:1008-10.
- Camargo CA Jr, Weiss ST, Zhang S, et al. Prospective study of body mass index, weight change, and risk of adult-onset asthma in women. Arch Intern Med 1999; 159:2582-8.
- Boulet LP, Des Cormiers A. The link between obesity and asthma: a Canadian per- spective. Can Respir J 2007;14:217-20.
- Chen Y, Dales R, Krewski D, et al. Increased effects of smoking and obesity on asthma among female Canadians: the National Population Health Survey, 1994-1995. Am J Epidemiol 1999;150:255-62.
- Sharp JT, Henry JP, Sweany SK, et al. The total work of breathing in normal and obese men. J Clin Invest 1964;43:728-39.
- Babb TG, Ranasinghe KG, Comeau LA, et al. Dyspnea on exertion in obese women: association with an increased oxygen cost of breathing. Am J Respir Crit Care Med 2008;178:116-23.
- Aaron SD, Fergusson D, Dent R, et al. Effect of weight reduction on respiratory function and airway reactivity in obese women. Chest 2004;125:2046-52.
- Hartge P, Brinton L, Rosenthal J, et al. Random digit dialing in selecting a popula- tion-based control group. Am J Epidemiol 1984;120:825-33.
- American Thoracic Society. Guidelines for methacholine and exercise challenge testing. Am J Respir Crit Care Med 2000;161:309-29.
- Juniper EF, Buist AS, Cox FM, et al. Validation of a standardized version of the Asthma Quality of Life Questionnaire. Chest 1999;115:1265-70.
- Dauer E, Thompson D, Zinmeister AR, et al. Supraesophageal reflux: validation of a symptom questionnaire. Otolaryngol Head Neck Surg 2006;134:73-80.
- American Thoracic Society. Standardization of spirometry -1987 update. State- ment of the American Thoracic Society. Am Rev Respir Dis 1987;136:1285-98.
- Juniper EF, Guyatt GH, Willan A, et al. Determining a minimal important change in a disease-specific quality of life questionnaire. J Clin Epidemiol 1994;47:81-7.
- Bjerg-Bäcklund A, Perzanowski MS, Platts-Mills TAE, et al. Asthma during the primary school ages -prevalence, remission and the impact of allergic sensitiza- tion. Allergy 2008;61:549-55.
- Ronmark E, Jonsson E, Lundback B. Remission of asthma in middle-aged and eld- erly-report from the Obstructive Lung Disease in Northern Sweden Study. Thorax 1999;54:611-3.
- Ronmark E, Lindberg A, Watson L, et al. Outcome of severity of adult onset asthma -report from the Obstructive Lung Disease in Northern Sweden Studies. Respir Med 2007;101:2370-7.
- Manfreda J, Sears MR, Becklake MR, et al. Geographic and gender variability in the prevalence of bronchial responsiveness in Canada. Chest 2004;125:1657-64.
- Juniper EF, Kline PA, Vanzieleghem MA, et al. Effect of long-term treatment with an inhaled corticosteroid (Budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis 1990;142:832-6.
- Marabini A, Cardinalini G, Severini C, et al. Is normal bronchial responsiveness in asthmatics a reliable index for withdrawing inhaled corticosteroid treatment? Chest 1998;113:964-7.
- Linden-Smith J. Morrison D, Deveau C, et al. Overdiagnosis of asthma in the com- munity. Can Respir J 2004;11:111-6.
- Schachter LM, Salome CM, Peat JK, et al. Obesity is a risk for asthma and wheeze but not airway hyper-responsiveness. Thorax 2001;56:4-8.
- Barraclough R, Devereux G, Hendrick DJ, et al. Apparent but not real increase in asthma prevalence during the 1990s. Eur Respir J 2002;20:826-33.
- Authors
- Aaron, S. D., Vandemheen, K. L., Boulet, L.-P., McIvor, R. A., FitzGerald, J. M., Hernandez, P., Lemiere, C., Sharma, S., Field, S. K., Alvarez, G. G., Dales, R. E., Doucette, S., Fergusson, D., & for the Canadian Respiratory Clinical Research Consortium
- Affiliations
- CMJ University (IN)
- University of Ottawa (CA)
- ORCID
- Venue
- Canadian Medical Association Journal
- Publisher
- CMA Impact Inc.
- Published
- 2008-11-18
- Volume
- 179
- Issue
- 11
- Pages
- 1121-1131
- ISSN
- 0820-3946 (ISSN-L)
- 1488-2329
- PMC
- PMC2582787
- OpenAlex
- W2147489728
- Cited by
- 400
- References
- 32
- Citations by year
- 2026: 8 · 2025: 7 · 2024: 17 · 2023: 15 · 2022: 17 · 2021: 12 · 2020: 15 · 2019: 17 · 2018: 28 · 2017: 23 · 2016: 21 · 2015: 31 · 2014: 27 · 2013: 36 · 2012: 37
- FWCI
- 19.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- Canadian Medical Association Journal (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Pfizer
- AstraZeneca
- GlaxoSmithKline
- Alexion Pharmaceuticals
- Genentech
- Canadian Institutes of Health Research
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Keywords
- obesity, asthma diagnosis, reversible airway obstruction, airway hyperresponsiveness, dyspnea, physician-diagnosed asthma
- MeSH terms
- Adult, Asthma, Body Weight, Canada, Diagnostic Errors, Female, Forced Expiratory Volume, Health Surveys, Humans, Longitudinal Studies, Male, Middle Aged, Obesity, Probability, Reference Values, Respiratory Function Tests, Sensitivity and Specificity, Severity of Illness Index, Spirometry, Body Mass Index, Prevalence, Confidence Intervals, Odds Ratio, Age Distribution, Sex Distribution
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
