An update on asthma diagnosis

OBJECTIVE

Asthma imposes a significant health and socioeconomic burden with an average prevalence impacting 5-10% of the global population. The aim of this narrative review is to update the current literature on topics related to asthma diagnosis.

DATA SOURCES

Original research articles were identified from PubMed using the search terms "asthma diagnosis" and "asthma misdiagnosis".

STUDY SELECTIONS

Recently published articles (n = 51) detailing the diagnosis, misdiagnosis of asthma, and the updated recommendations of the European and international asthma guidelines.

RESULTS

Emerging evidence revealed that asthma might represent a rather heterogenous clinical entity with varying underlying molecular mechanisms. Attempts have been made to unravel these traits to better provide accurate diagnosis and a more efficient patient-based management approach. The lack of a gold standard test for asthma diagnosis has contributed to its over- and underdiagnosis. This is problematic, given that overdiagnosis might lead to delay of both diagnosis and prompt treatment of other diseases, while underdiagnosis might substantially impact quality of life due to progression of asthma by increased rate of exacerbations and airway remodeling. In addition to poor asthma control and potential patient harm, asthma misdiagnosis is also associated with excessive costs. As a result, current international guidelines emphasize the need for a standardized approach to diagnosis, including objective measurements prior to treatment.

CONCLUSION

Future research is warranted to define the optimal diagnostic and treatable traits approach especially for patients with severe asthma, as they may benefit from the advent of newly targeted asthma management.

Global Mental Health Research: Time to Integrate Basic Science

The Lancet Commission on Global Mental Health recommends the inclusion of research on the biological underpinnings of mental disorders as part of efforts to reduce the global burden of mental disorders. The search for defining features of mental disorders in non-Euro American settings is historically charged for the field. Yet, as illustrated by analysis of the NIMH objectives, the biological study of mental disorders cannot be scientifically sound without better inclusion of under-represented, globally diverse populations. It is time for global mental health researchers to take up the challenge and advance impactful research across the full translational spectrum.

Alcoholic liver disease - the extent of the problem and what you can do about it

It takes upwards of ten years for alcohol-related liver disease to progress from fatty liver through fibrosis to cirrhosis to acute on chronic liver failure. This process is silent and symptom free and can easily be missed in primary care, usually presenting with advanced cirrhosis. At this late stage, management consists of expert supportive care, with prompt identification and treatment of bleeding, sepsis and renal problems, as well as support to change behaviour and stop harmful alcohol consumption. There are opportunities to improve care by bringing liver care everywhere up to the standards of the best liver units, as detailed in the Lancet Commission report. We also need a fundamental rethink of the technologies and approaches used in primary care to detect and intervene in liver disease at a much earlier stage. However, the most effective and cost-effective measure would be a proper evidence-based alcohol strategy.