A decade ago several research studies highlighted the underdiagnosis of asthma, particularly in children1-3 but also in the elderly,4 ,5 and most general practitioners felt an increased pressure on them to diagnose this common chronic respiratory disorder. It was implied that asthma should be considered whenever a patient presented with a persistent cough and that far more people “deserved” to be on effective treatment with inhaled steroids. Undoubtedly, as a consequence of this message, many with asthma gained treatment which otherwise would not have been provided and, presumably, improved their morbidity and quality of life.

However, there has emerged a down side to this campaign in that some subjects with other respiratory conditions and some with no lung disease at all have been labelled as having asthma, leading not only to years of receiving unnecessary medication but also to the development of psychological dependence on the asthma label and its associated quest for improvements in symptom control. Most of such subjects have chronic obstructive pulmonary disease (COPD), but in my clinical practice I have also found cases of hyperventilation, recrudescent tuberculosis, and severe sleep apnoea …