User:Beiyulin/sandbox

Introduction
Reactive airway disease is a group of conditions that include reversible airway narrowing due to an external stimulation. These conditions generally result in wheezing '''is a loose term used by many physicians to label patients with symptoms similar to those of asthma, most commonly for pediatric patients. An exact definition of the condition does not exist and it can not be used as a real diagnosis for physicians. 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.'''

'''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.'''

Conditions within this group include asthma, chronic obstructive pulmonary disease, and viral upper respiratory infections.

The term reactive airway disease may be used in pediatrics to describe an asthma-like syndrome in infants too young for diagnostic testing such as the bronchial challenge test. These infants may later be confirmed to have asthma following testing. The term is sometimes often misused as a synonym for asthma.

Use of the term
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.

RAD is most commonly used by physicians when they are hesitant to diagnose a patient with asthma. This is most common 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, tests 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. 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.

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.

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

Reactive airways dysfunction syndrome is 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. It can manifest in adults with exposure to high levels of chlorine, ammonia, acetic acid or sulphur dioxide, creating symptoms like asthma. 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. Some experts classify RADS as occupational asthma. Those with exposure to highly irritating substances should receive treatment to mitigate harmful effects.

The main difference between RAD and RADS is that RADS can occur after just one exposure to the inhalants and without any prior sensitization. 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.

Controversy over use
There remains controversy over the use of RAD as a term in medical lexicon. With its use not only being limited to clinical lexicon as this time, but also transitioning to clinical literature, some physicians disapprove of 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, is not listed by any major medical journal, and is also not recognized in the American Academy of Pediatrics, the American Thoracic Society, or the National Heart Lung and Blood Institute. 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.

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, which can lead to problems for healthcare facilities.

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.