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Difficult Asthma often wrongly diagnosed

Doctors found that out of 60 children diagnosed with 'difficult asthma' only 5 were actually confirmed with the condition. A research team came to this conclusion in a study that completely changed the children's environment.
They found that by avoiding allergens and factors that are known to exacerbate asthma a significant health gain was possible. This led the team to report that the correct diagnosis of 'difficult asthma' was rare. The health gain had previously been noted in clinical investigations 30 years ago. See references 2 and 3.

Difficult asthma is defined as poorly controlled asthma. In this category patients experience chronic symptoms, punctuated by exacerbations of asthma plus a continued requirement for short-acting (reliever) inhalers despite a high daily dosage of steroids for 6 months or longer. To test the validity of the diagnosis and treatment for 'difficult asthma' researchers in Belgium investigated sixty children diagnosed with the condition. Their study took the children away from their home environment and placed them in a low allergen residential setting for between 3 and 8 months depending upon the child. During the study period doctors monitored the children's symptoms and their reliance upon medication. They found that by removing the children from adverse environmental or social factors a health gain could be achieved. The adverse factors included, passive smoke, non-compliance of medication, exposure to common asthma triggers and personal stress.

Benefits from the study? There is an urgent need to identify and reduce the cost of asthma on society as a whole. In India, the monthly cost of drugs for one asthmatic child can amount to one third of the family's monthly income. In the United States reports indicate that childhood asthma results in 14 million missed days off school each year, and in the UK (during 2002) over twenty eight thousand asthmatic children were admitted to hospital because of the disease and cost the country's taxpayers a whopping 2.3 billion that year. Much of this cost came from patients diagnosed with 'difficult asthma'.


  1. Difficult Asthma: Can Symptoms be Controlled in a Structured Environment? De Boeck K, Moens M, Va der Aa N Meersman A, Schuddinck L, Proesmans M, 2009, 'Pediatric Pulmonology' 44: p 743-748
  2. 'Reduction of bronchial hyperactivity during prolonged allergen avoidance'. Platts-Mills TA, Tovey ER, Mitchell EB, Moszoro H, Nock P, Wilkins SR, 'Lancet' 1982;2: 675-678
  3. Alternative treatments for asthma: assessing the need, Szefler SJ, Kamada AK, Hughes D, Brenner AM, J. 'Asthma',1992
  4. Taking Your Child's Breath Away. The Extension of Asthma's Global Reach, Mantzouranis E C, 2008, 'N. Eng. J. of Med', 358;12, p.1211-121
  5. Where Do We Stand, asthma in the UK today', 2004, 'Asthma UK' publication, registered charity 802364