Sunday, April 4, 2010
I learned something new. I was educating a parent, whose child came to me with the diagnosis of "reactive airways disease" (RAD). I said this term was a very old term that was confusing. I was half-right and half-wrong.
According to PubMed, "reactive airways disease" was first used in 1975. However, the term gained wider use after an article by Brooks, Weiss and Bernstein in 1985. Their article was actually titled "Reactive airways dysfunction syndrome (RADS): Persistent asthma syndrome after high level irritant exposures". From there, RADS morphed into RAD and has been used increasingly in the lay press, along patients, and among primary care physicians. So I can say it's very old, since RAD is younger than I am. From now on, I'm saying it's a relatively new lay term used to describe the combination of coughing, wheezing and chest congestion, usually in children, like asthma. RAD is a blanket term that does not have a strict scientific definition. Often is reflects uncertainty about the exact diagnosis, sometimes because it is difficult to diagnose asthma in children compared to adults, and a reluctance by physicians and patients to be diagnosed with asthma. Most people recoil. I have had loud and vigor discussions with parents and patients about being diagnosed with asthma. I'd say about 75% take it well and the other 25% do not. Some of my patients kept calling it RAD or my wheezy cough, but not asthma.
One measure of how indistinct "reactive airways disease" is that none of the "International Statistical Classification of Diseases and Related Health Problems (most commonly known by the abbreviation ICD)" recognizes this term. The World Health Organization uses this classification to aid in comparing diseases. Neither ICD-9 nor ICD-10 recognize nor use this term. ICD-9, which was published in 1978, and is still used to capture morbidity data in the U.S. ICD-10, which was published in 1999, and is used to report morbidity data in the U.S. If you look in the indexes for either, RAD is not listed.
You can even google the term and see what a mixed bag of results you get. There is no uniformity.
I am not alone, thankfully. Bigger guns have said the same: James Li, M.D., at the Mayo Clinic, and Fahey and O'Byrne (a well written article that says it all).
That's it for this educational history lesson. I never use this term. It is vague, unscientific, and not officially recognized. Look if we're certain it is a mango, then call it a mango. I am sorry to be the bearer of bad news. Definitely don't get any ideas about shooting the messenger from Shakespeare. Let's be clear about our communication. We have so many, many, many other things that we mess up.Your Allergy Dude