Reactive airway disease

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Reactive airway disease
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Reactive airway disease is a general term used by many physicians to label patients with symptoms similar to those of asthma. It is most commonly used when a physician is hesitant about formally diagnosing a patient with asthma, which is most prevalent in the pediatric setting for a variety of reasons. While some physicians may use RAD and asthma synonymously, this causes controversy, since RAD can not be used as a real diagnosis for physicians.[1] An exact definition of the condition does not exist.[2] Individuals that are typically labeled as having reactive airway disease, or RAD, generally have a history of wheezing, coughing, dyspnea, and production of sputum that may or may not be caused by asthma. Symptoms may also include, but are not limited to, coughing, shortness of breath, excess mucus in the bronchial tube, swollen mucous membrane in the bronchial tube, and/or hypersensitive bronchial tubes.[1]

RAD can be confused with reactive airways dysfunction syndrome, an asthma-like disorder that results from high exposure to vapors, fumes, and/or smoke. Unlike RAD, reactive airways dysfunction syndrome is recognized by multiple societies as a real clinical syndrome, including the American Thoracic Society and the American College of Chest Physicians.[3]

There is controversy over its use in the healthcare setting, largely due to the ambiguous definition that the term has.[4] Since the term is not recognized as a real clinical diagnosis, its meaning is highly inconsistent and may cause confusion and misdiagnosis within the medical community. There are also concerns with overtreatment and undertreatment with RAD amongst physicians, since there is little formality with the label. Other problems that healthcare workers have with the use of the term RAD include its exclusion in the International Statistical Classification of Diseases and Related Health Problems, which can lead to billing issues in hospitals and other health care facilities, and the creation of a fabricated sense of security when using it has a diagnosis as well.[3]

Use of the term[edit]

It is common to see RAD incorrectly used as a synonym for asthma

Reactive airway disease originally began to appear in medical literature in the 1980s as a term used to describe asthmatic patients with hyperactive airways, a common feature of asthma. This feature is characterized by increased bronchoconstriction reactions in response to stimuli that should not elicit as strong of response. These stimuli can include methacholine, histamine, and distilled water. However, while this was how the term initially was introduced, RAD soon began to be used interchangeably with the term asthma itself, which leads to the current controversy over its place in medical lexicon.[4]

Some physicians will use RAD and asthma synonymously, which leads to the controversy over its place in the healthcare setting[1]. However, more commonly, RAD is now mostly used by physicians when they are hesitant to diagnose a patient with asthma. This is most prominent in the pediatric setting for a variety of reasons. While infants tend to wheeze more often than adults, only one third of them eventually go on to actually have asthma. Asthma and viral bronchiolitis can also be nearly identical to each other when presented in very young children, since they both consist of wheezing, coughing, and nasal congestion. In addition, typical tests used to accurately diagnose children with asthma, such as the bronchial challenge test, are not considered to be accurate for children under the age of 5. This can be due to failure of very young children to cooperate.[4][5] There also exists a certain "negative connotation" that comes with diagnosing a child with asthma, causing hesitancy from some physicians to do so. All of these factors lead physicians to label young children with RAD instead of asthma, since the disease is often only suspected and unable to be confirmed with pediatric patients.[2]

Physicians will generally label an adult with RAD if they have no prior diagnosis or history of asthma, however he or she exhibits symptoms of wheezing, production of sputum, and/or the use of an inhaler.[2] Symptoms may also include, but are not limited to, coughing, shortness of breath, excess mucus in the bronchial tube, swollen mucous membrane in the bronchial tube, and/or hypersensitive bronchial tubes.[1] In order to make a formal asthma diagnosis in adult patients, there is requirement to have documentation of either airway hyperreactivity or some sort of reversible airway obstruction. If none of this is present in an adult patients' medical history or documentation, physician may label the patient with RAD instead of asthma in order to still indicate there is an airway issue without formal diagnosis.[3]

Reactive airways dysfunction syndrome[edit]

While the acronyms are similar, reactive airway disease (RAD) and reactive airways dysfunction syndrome (RADS) are not the same.

Reactive airways dysfunction syndrome was a term proposed by Stuart M. Brooks and colleagues in 1985 to describe an asthma-like syndrome developing after a single exposure to high levels of an irritating vapor, fume, or smoke.[6][3] It can manifest in adults with exposure to high levels of chlorine, ammonia, acetic acid or sulphur dioxide, creating symptoms like asthma.[7] These symptoms can vary from mild to fatal, and can even create long-term airway damage depending on the amount of exposure and the concentration of chlorine. Patients that have been diagnosed with RADS will likely have methacholine airway hyperreactivity, yet other tests that also measure pulmonary functions may appear normal.[3] Some experts classify RADS as occupational asthma. Those with exposure to highly irritating substances should receive treatment to mitigate harmful effects.[8] Treatment for RADS is similar to treatment for other disorders that result from acute inhalation. These can include, but are not limited to, aerosolized bronchodilators and inhaled steroids.[9]

The main difference between RAD and RADS is that RADS can occur after just one exposure to the inhalants and without any prior sensitization. In addition, although the symptoms of RADS are very similar to those of asthma, they may be resolved. While some physicians argue that RADS is also not a real clinical syndrome, it is more commonly recognized in legitimate associations than RAD. These associations include the American Thoracic Society and the American College of Chest Physicians.[3]

Controversy over use[edit]

First page of the 2010 ICD

There remains controversy over the use of RAD as a term in medical lexicon. With its use not only being limited to clinical lexicon, but also transitioning to clinical literature now, more physicians are now increasingly disapproving its use in the healthcare setting.

One of the largest problems with the using RAD as a diagnostic label lies in the ambiguity of its meaning. This issue is due to the fact that RAD has no true clinical definition. It is either not listed or redirects to "asthma" in all major medical journal or website. In addition to that, it is also not recognized in the American Academy of Pediatrics, the American Thoracic Society, or the National Heart Lung and Blood Institute.[4] In addition, treatments for asthma, chronic bronchitis, emphysema, or pneumonia may not be prescribed under a label of reactive airway disease. In contrast, some physicians also fear overtreatment for RAD, as patients can be prescribed inhaled beta-agonists or inhaled corticosteroids, which are medications used for asthma. Since individuals with RAD do not necessarily have asthma, these treatments would be necessary. As a result of its ambiguous place in the medical field, the symptoms used to characterize it are often inconsistent and can lead to confusion in a healthcare setting. This is a troubling issue for many physicians, as care can be made more complicated; many patients labeled with RAD do not ultimately have asthma and most RAD patients have never formally had their airway reactivity measured.[3]

In addition to the inconsistencies of its use, there is also no billing designation for RAD in the International Statistical Classification of Diseases and Related Health Problems, or the ICD, which can lead to problems for healthcare facilities. When trying to search for it in the ICD, it tells to "see asthma." [4] Some medical professional argue that using RAD as a diagnosis will only complicate research on asthma in the context of clinical research and epidemiology as well. There is also dispute that by giving physicians the ability to label a patient with RAD, it gives them a fabricated sense of security that they have made a diagnosis, when no real recognizable diagnosis has been concluded.[3]

See also[edit]

References[edit]

  1. ^ a b c d "Reactive Airway Disease: Definition, Symptoms, and Treatment". Healthline. Retrieved 2018-12-04.
  2. ^ a b c "Definition of Reactive Airways Disease".
  3. ^ a b c d e f g h FAHY, JOHN V.; O'BYRNE, PAUL M. (2001-03-15). ""Reactive Airways Disease"". American Journal of Respiratory and Critical Care Medicine. 163 (4): 822–823. doi:10.1164/ajrccm.163.4.2005049. ISSN 1073-449X.
  4. ^ a b c d e Douglas, Lindsey C.; Feder, Katherine J. (2017-01-01). "RAD: Reactive Airways Disease or Really Asthma Disease?". Pediatrics. 139 (1): e20160625. doi:10.1542/peds.2016-0625. ISSN 0031-4005. PMID 28031454.
  5. ^ "Reactive airway disease: Is it asthma?". Mayo Clinic. Retrieved 2018-11-30.
  6. ^ S.M. Brooks; M.A. Weiss; I.L. Bernstein. "Reactive airways dysfunction syndrome (RADS): persistent asthma syndrome after high level irritant exposures". Chest, Volume 88, 1985, 376-384. Retrieved 2007-08-28.
  7. ^ Shakeri, M. S.; Dick, F. D.; Ayres, J. G. (2008-05-01). "Which agents cause reactive airways dysfunction syndrome (RADS)? A systematic review". Occupational Medicine. 58 (3): 205–211. doi:10.1093/occmed/kqn013. ISSN 0962-7480.
  8. ^ Aslan, Sahin; Kandiş, Hayati; Akgun, Metin; Çakır, Zeynep; Inandı, Tacettin; Görgüner, Metin (2006). "The effect of nebulized NaHCO3 treatment on 'RADS' due to chlorine gas inhalation". Inhalation Toxicology. 18 (11): 895–900. doi:10.1080/08958370600822615.
  9. ^ "Irritant-Induced Asthma and Reactive Airways Dysfunction Syndrome (RADS)".

External links[edit]

Classification
External resources