Asthma is diagnosed on the basis of respiratory symptoms of wheeze, cough, chest tightness, and/or dyspnea together with physiologic evidence of variable expiratory airflow limitation. The prevalence of asthma varies widely around the world, ranging from 0.2% to 21.0% in adults and from 2.8% to 37.6% in 6- to 7-year-old children. Population-based studies in children, adults, and the elderly suggest that from 20% to 70% of people with asthma in the community remain undiagnosed and hence untreated. Underdiagnosis of asthma has been found to be associated with underreporting of respiratory symptoms by patients to physicians as well as poor socioeconomic status. On the opposite side of the spectrum, studies of patients with physician-diagnosed asthma suggest that 30-35% of adults and children diagnosed with asthma do not have current asthma, suggesting that asthma is also overdiagnosed in the community. Overdiagnosis of current asthma can occur because of physicians' failure to confirm variable airflow limitation at the time of diagnosis or when sustained clinical remission of disease goes unrecognized. In this review, we define under- and overdiagnosis and explore the prevalence and burden of under- and overdiagnosis of asthma both in patients and within healthcare systems. We further describe potential solutions to prevent under- and overdiagnosis of asthma.

中文翻译：

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哮喘的诊断不足和过度诊断。

哮喘是根据喘息，咳嗽，胸闷和/或呼吸困难的呼吸道症状以及呼气气流受限的生理证据诊断的。全世界的哮喘患病率差异很大，成年人的哮喘患病率为0.2％至21.0％，而6至7岁的儿童则为2.8％至37.6％。在儿童，成人和老年人中进行的基于人群的研究表明，社区中20％至70％的哮喘患者仍未得到诊断，因此未得到治疗。已发现哮喘诊断不足与患者向医生报告呼吸道症状不足以及社会经济状况差有关。相反，对医生诊断为哮喘的患者进行的研究表明，被诊断出患有哮喘的成年人和儿童中，有30％至35％的人目前没有哮喘，这表明社区也对哮喘进行了过度诊断。当前的哮喘过度诊断可能是由于医生在诊断时或持续的临床疾病缓解未能确认时无法确定可变气流限制而引起的。在这篇综述中，我们定义了诊断不足和过度诊断，并探讨了患者和医疗系统内哮喘诊断不足和过度诊断的患病率和负担。我们进一步描述了潜在的解决方案，以防止对哮喘的诊断不足和过度诊断。我们定义了诊断不足和过度诊断的方法，并探讨了患者和医疗系统中哮喘诊断不足和过度诊断的患病率和负担。我们进一步描述了潜在的解决方案，以防止对哮喘的诊断不足和过度诊断。我们定义了诊断不足和过度诊断的方法，并探讨了患者和医疗保健系统中哮喘诊断不足和过度诊断的患病率和负担。我们进一步描述了潜在的解决方案，以防止对哮喘的诊断不足和过度诊断。