ArticleThorax2000
Underdiagnosis of asthma: is the doctor or the patient to blame? The DIMCA project.
Article in Thorax, 2000. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 53 papers, 2 of them syntheses that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
53 citing papers in PubMed, 2 syntheses or guidelines pooled it, 205 citations in OpenAlex.
- Digital interventions to improve adherence to maintenance medication in asthma.The Cochrane database of systematic reviews · 2022Pooled it
- The current status of asthma in Korea.Journal of Korean medical science · 2006Pooled it
- Efficacy of confrontational counselling for smoking cessation in smokers with previously undiagnosed mild to moderate airflow limitation: study protocol of a randomized controlled trial.BMC public health · 2007Trial
- Asthma is under-recognized and undermanaged in the Malaysian university population: A comparison of findings from Malaysia against Singapore from the Singapore/Malaysia cross-sectional genetic epidemiology study.The World Allergy Organization journal · 2026Article
- Appropriate Use of Single Inhaled Triple Therapy in Uncontrolled Asthma: A Multinational Modified Delphi Consensus.Journal of asthma and allergy · 2026Article
- The Impact of Obesity on Airway Inflammation, Lung Function and Biologic Treatment in Asthma: A Narrative Review.Journal of inflammation research · 2026Review
- Asthma underdiagnosis in children: A school-based screening in a low socioeconomic status population.Biomedica : revista del Instituto Nacional de Salud · 2025Article
- 30-day Spirometry Holter method design and prospective observational study.Scientific reports · 2024Observational
- Article
- Early Diagnosis and Treatment of Chronic Obstructive Pulmonary Disease: The Costs and Benefits of Case Finding.American journal of respiratory and critical care medicine · 2024Article
- Value of Fractional Exhaled Nitric Oxide in Diagnosing Mild Asthma Responsive to Inhaled Corticosteroids.Journal of clinical medicine · 2023Article
- Assessing the prognostic value of respiratory oscillometry in patients with difficult-to-treat asthma.Scientific reports · 2023Article
- Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update.NPJ primary care respiratory medicine · 2023Review
- Accuracy of the COPD diagnostic questionnaire as a screening tool in primary care.BMC primary care · 2022Article
- Misperception of poor asthma control in the outpatients clinic of a tertiary hospital in Rio de Janeiro.Einstein (Sao Paulo, Brazil) · 2022Article
- Risk Factors for the Absence of Diagnosis of Asthma Despite Disease Symptoms: Results from the Swedish GA2LEN Study.Journal of asthma and allergy · 2022Article
- Underdiagnosis of obstructive lung disease: findings from the French CONSTANCES cohort.BMC pulmonary medicine · 2021Article
- The asthma predictive index as a surrogate diagnostic tool in preschoolers: Analysis of a longitudinal birth cohort.Pediatric pulmonology · 2021Article
- Asthma diagnosis: into the fourth dimension.Thorax · 2021Review
- Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundIt is important to diagnose asthma at an early stage as early treatment may improve the prognosis in the long term. However, many patients do not present at an early stage of the condition so the physician may have difficulty with the diagnosis. A study was therefore undertaken to compare the proportion of patients who underpresented their respiratory symptoms with the proportion of underdiagnosed cases of asthma by the general practitioner (GP). A secondary aim was to investigate whether bad perception of dyspnoea by the patient was a determining factor in the underpresentation of asthma symptoms to the GP.
methodsA random sample of 1155 adult subjects from the general population in the eastern part of the Netherlands was screened for respiratory symptoms and lung function and the results were compared with the numbers of asthma related consultations registered in the medical files of the GP. In subjects with reduced lung function the ability to perceive dyspnoea was investigated during a histamine provocation test in subjects who did and did not report their symptoms to their GP.
resultsOf the random sample of 1155 subjects 86 (7%) had objective airflow obstruction (forced expiratory volume in one second (FEV(1)) below the reference value corrected for age, length, and sex minus 1.64SD on two occasions) and had symptoms suggestive of asthma. Of these 86 subjects only 29 (34%) consulted the GP, which indicates underpresentation by 66% of patients. Of all subjects with objective airflow obstruction who presented to their GP with respiratory symptoms, 23 (79%) were recorded in the medical files as having asthma, indicating underdiagnosis by the GP in 21% of cases. Of the subjects with objective airflow obstruction who visited the GP with respiratory symptoms 6% had bad perception of dyspnoea compared with 26% of those who did not present to the GP in spite of airflow obstruction (chi(2) = 3.02, p = 0.08).
conclusionsUnderpresentation to GPs of respiratory symptoms by asthmatic patients contributes significantly to the problem of underdiagnosis of asthma. Underdiagnosis by the GP seems to play a smaller role. Furthermore, there are indications that underpresentation of symptoms by the patient is at least partly explained by a worse perception of dyspnoea.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.