Approaches to Asthma Diagnosis in Children and Adults

Abstract

Although the hallmark features of asthma include reversible airflow obstruction, airway eosinophilia, and symptoms of recurrent wheeze associated with breathlessness and cough, it is a heterogeneous disease. The extent of the pathophysiological abnormalities are variable between patients. Despite this, until recently, asthma diagnosis had been made very simplistically predominantly from a clinical history and examination, and often a trial of medication such as short acting bronchodilators. The limitations of this approach have become increasingly apparent with evidence of inappropriate over diagnosis, under diagnosis and misdiagnosis. Although there is no gold standard single test to make a diagnosis of asthma, there are several objective tests that can be used to support the diagnosis including physiological measures such as obstructive spirometry associated with bronchodilator reversibility and airway hyperresponsiveness. In addition, non-invasive tests of airway inflammation such as exhaled nitric oxide or peripheral blood eosinophils are important to identify those with an allergic or eosinophilic phenotype. Diagnostic guidelines reflect the importance of using objective tests to support a diagnosis of asthma, however practical application in the clinic may not be straightforward. The focus of this review is to discuss the need to undertake objective tests in all patients to support asthma diagnosis and not just rely on clinical features. The advantages, challenges and limitations of performing tests of lung function and airway inflammation in the clinic, the difficulties related to training and interpretation of results will be explored, and the utility and relevance of diagnostic tests will be compared in adults and children.

Serum ECP as a diagnostic marker for asthma in children less than 5 years: A systematic review and meta‐analysis

“…The diagnosis of childhood asthma remains challenging for physicians because of the absence of a standard definition and gold standard test 3,4 . Rather, it consists of a clinical diagnosis based on a characteristic pattern of symptoms and signs in the absence of an alternative explanation 4 . Use of spirometry and lung function tests are too invasive for use in young children.…”

The efficacy of the combination of exhaled nitric oxide and blood eosinophil count in the diagnosis of asthma in China

“…[1,26,29,33] B-Eos count, another promising and easy-to-measure biomarker, is more attractive as a means of diagnosing asthma. [6,34] In this study, we found that the optimal diagnostic cutoff level was 203 cells/µl for B-Eos to identify asthma. Consistent with previous reports, [13,35] our data indicated that FeNO or B-Eos count alone had only moderate accuracy for diagnosing asthma, so using a single biomarker for this purpose will yield many false negatives and false positives.…”

“…[5] However, there are several limitations to objective tests. [6] The BPT is time consuming, has a risk of triggering asthma attack, and is generally not available in primary care; the BDT has limited value for distinguishing asthma from chronic airway diseases; and variable peak expiratory ow requires good cooperation and adherence. [26][27][28] Conspicuously, the UK National Institute for Health and Care Excellence (NICE) recommends that FeNO, a potential indirect predictor of Th2 airway in ammation in asthma, should be measured in all suspected asthma patients.…”

“…[3,4] The main reason is that the common symptoms of asthma are relatively non-speci c, [5] and the objective tests recommended by the Global Initiative for Asthma (GINA), including the bronchial-provocation test (BPT) and the bronchodilation test (BDT), require complex cooperation from patients, over long durations of examination time, and might pose certain risks. [5,6] Therefore, nding a simple and effective method for diagnosing asthma is an urgent clinical problem.…”

Effects of Blatta orientalis on Treatment of Bronchial Asthma: A Prospective, Non-Randomised, Open-Label, Observational Study

“…The presence of an obstructive picture, with a ratio of forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) <70%, and associated reversibility following administration of bronchodilator is found in cases of asthma. 6 The primary goal of asthma management is to achieve and maintain control of the disease to prevent exacerbations and reduce the risk of morbidity and mortality. The treatment goal of conventional or other therapies is to reduce the frequency and severity of the asthma symptoms, to reduce the intake of reliever medications (inhalers) and to improve lung function.…”