Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Dec;5(2):103-115.
doi: 10.1007/s41030-019-0093-y. Epub 2019 Jul 1.

Asthma Diagnosis: The Changing Face of Guidelines

Sarah M Drake  1   2 , Angela Simpson  3   4 , Stephen J Fowler  3   4
Affiliations
Review

Asthma Diagnosis: The Changing Face of Guidelines

Sarah M Drake et al. Pulm Ther. 2019 Dec.

Abstract

Asthma, the most common chronic respiratory disease, is frequently misdiagnosed, and accounts for a significant proportion of healthcare expenditure. This has driven the National Institute for Health and Care Excellence (NICE) in the United Kingdom (UK) to produce recent guidance; in places, this contrasts to that of the British Thoracic Society/Scottish Intercollegiate Guideline Network (BTS/SIGN), which have been producing their own guidance since 2003. Here we review the history of asthma diagnostic guidelines, and compare and review the evidence behind them, in adults and in children. We discuss the definitions of asthma and how these drive the concepts behind diagnostic strategies. We anticipate future directions in asthma diagnosis which will take into account the concepts of personalised medicine and disease endotypes. We also consider the utility of tests in use now and in the future, in particular novel tests relating to small airway inflammation and obstruction.

Keywords: Asthma; Diagnosis; Endotype; Guidelines; Impulse oscillometry (IOS); Multiple-breath washout (MBW); Paediatric; Phenotype; Treatable trait; Volatile organic compounds (VOCs).

PubMed Disclaimer

Figures

Fig. 1
Fig. 1
Evolution of asthma guidelines
Fig. 2
Fig. 2
BTS diagnostic algorithm [36] (This figure is reproduced from the BTS/SIGN British Guideline on the Management of Asthma by kind permission of the British Thoracic Society)
Fig. 3
Fig. 3
NICE diagnostic algorithm in children [17]: https://www.nice.org.uk/guidance/ng80/resources/algorithm-b-objective-tests-for-asthma-in-children-and-young-people-aged-5-to-16-pdf-4656176750. Asthma: diagnosis, monitoring and chronic asthma management (NG80)
Fig. 4
Fig. 4
NICE diagnostic algorithm in adults [17]: https://www.nice.org.uk/guidance/ng80/resources/algorithm-c-objective-tests-for-asthma-in-adults-aged-17-and-over-pdf-4656176751
See this image and copyright information in PMC

References

    1. Aaron SD, Vandemheen KL, FitzGerald JM, Ainslie M, Gupta S, Lemiere C, et al. Reevaluation of diagnosis in adults with physician-diagnosed asthma. JAMA. 2017;317(3):269–279. doi: 10.1001/jama.2016.19627. - DOI - PubMed
    1. Agache I, Akdis C, Jutel M, Virchow JC. Untangling asthma phenotypes and endotypes. Allergy. 2012;67(7):835–846. doi: 10.1111/j.1398-9995.2012.02832.x. - DOI - PubMed
    1. Agusti A, Bel E, Thomas M, Vogelmeier C, Brusselle G, Holgate S, et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur Respir J. 2016;47(2):410–419. doi: 10.1183/13993003.01359-2015. - DOI - PubMed
    1. Almstrand AC, Josefson M, Bredberg A, Lausmaa J, Sjovall P, Larsson P, et al. TOF-SIMS analysis of exhaled particles from patients with asthma and healthy controls. Eur Respir J. 2012;39(1):59–66. doi: 10.1183/09031936.00195610. - DOI - PubMed
    1. Asher MI, Keil U, Anderson HR, Beasley R, Crane J, Martinez F, et al. International Study of Asthma and Allergies in Childhood (ISAAC): rationale and methods. Eur Respir J. 1995;8(3):483–491. doi: 10.1183/09031936.95.08030483. - DOI - PubMed

LinkOut - more resources