Misdiagnosis (over-diagnosis and under-diagnosis) of asthma is common. Under-diagnosis can lead to avoidable morbidity and mortality, while over-diagnosis exposes patients to unnecessary side effects of treatment(s) and results in unnecessary healthcare expenditure. We explored diagnostic approaches and challenges faced by general practitioners (GPs) and practice nurses when making a diagnosis of asthma. Fifteen healthcare professionals (10 GPs and 5 nurses) of both sexes, different ages and varying years of experience who worked in NHS Lothian, Scotland were interviewed using in-depth, semi-structured qualitative interviews. Transcripts were analysed using a thematic approach. Clinical judgement of the probability of asthma was fundamental in the diagnostic process. Participants used heuristic approaches to assess the clinical probability of asthma and then decide what tests to do, selecting peak expiratory flow measurements, spirometry and/or a trial of treatment as appropriate for each patient. Challenges in the diagnostic process included time pressures, the variable nature of asthma, overlapping clinical features of asthma with other conditions such as respiratory viral illnesses in children and chronic obstructive pulmonary disease (COPD) in adults. To improve diagnostic decision-making, participants suggested regular educational opportunities and better diagnostic tools. In the future, standardising the clinical assessment made by healthcare practitioners should be supported by improved access to diagnostic services for additional investigation(s) and clarification of diagnostic uncertainty.

中文翻译：

---

对基层医疗机构进行哮喘诊断时的实践和挑战的定性研究。

哮喘的误诊（过度诊断和诊断不足）很常见。诊断不足会导致可避免的发病率和死亡率，而过度诊断会使患者面临不必要的治疗副作用，并导致不必要的医疗保健支出。我们探讨了诊断哮喘时全科医生（GPs）和执业护士所面临的诊断方法和挑战。通过深入，半结构化的定性访谈，采访了在苏格兰NHS洛锡安工作的15名男女，不同年龄和不同经验的医疗保健专业人员（10名全科医生和5名护士）。使用主题方法分析成绩单。对哮喘可能性的临床判断是诊断过程的基础。参与者使用启发式方法评估哮喘的临床可能性，然后决定进行哪些测试，选择适合每个患者的呼气峰流量测量值，肺活量测定法和/或治疗试验。诊断过程中的挑战包括时间压力，哮喘的可变性，哮喘的临床特征与其他疾病（例如儿童的呼吸道病毒病和成人的慢性阻塞性肺病）的重叠。为了改善诊断决策，参与者建议定期接受教育，并使用更好的诊断工具。将来，应该通过改善获得诊断服务以进行进一步研究和明确诊断不确定性的支持，来规范医护人员进行的临床评估的标准化。