European Respiratory Society guidelines for the diagnosis of asthma in adults
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European Respiratory Society guidelines for the diagnosis of asthma in adults. / Louis, Renaud; Satia, Imran; Ojanguren, Inigo; Schleich, Florence; Bonini, Matteo; Tonia, Thomy; Rigau, David; Brinke, Anne ten; Buhl, Roland; Loukides, Stelios; Kocks, Janwillem W. H.; Boulet, Louis-Philippe; Bourdin, Arnaud; Coleman, Courtney; Needham, Karen; Thomas, Mike; Idzko, Marco; Papi, Alberto; Porsbjerg, Celeste; Schuermans, Daniel; Soriano, Joan B.; Usmani, Omar S.
In: European Respiratory Journal, Vol. 60, No. 3, 2101585, 2022.Research output: Contribution to journal › Review › Research › peer-review
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TY - JOUR
T1 - European Respiratory Society guidelines for the diagnosis of asthma in adults
AU - Louis, Renaud
AU - Satia, Imran
AU - Ojanguren, Inigo
AU - Schleich, Florence
AU - Bonini, Matteo
AU - Tonia, Thomy
AU - Rigau, David
AU - Brinke, Anne ten
AU - Buhl, Roland
AU - Loukides, Stelios
AU - Kocks, Janwillem W. H.
AU - Boulet, Louis-Philippe
AU - Bourdin, Arnaud
AU - Coleman, Courtney
AU - Needham, Karen
AU - Thomas, Mike
AU - Idzko, Marco
AU - Papi, Alberto
AU - Porsbjerg, Celeste
AU - Schuermans, Daniel
AU - Soriano, Joan B.
AU - Usmani, Omar S.
N1 - Publisher Copyright: Copyright © The authors 2022.
PY - 2022
Y1 - 2022
N2 - Although asthma is very common, affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice. The taskforce defined eight Population, Index, Comparator and Outcome questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The taskforce utilised the outcomes to develop an evidence-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences. The taskforce supports the initial use of spirometry followed by bronchodilator reversibility testing (if airway obstruction is present). If initial spirometry fails to show obstruction, further tests should be performed in the following order: exhaled nitric oxide fraction, peak expiratory flow variability, or, in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms. The taskforce reinforces spirometry as a priority and recognises the value of measuring blood eosinophils and serum immunoglobulin E to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved forced expiratory volume in 1 s/forced vital capacity ratio deserves further attention. The taskforce draws attention to the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids; the comorbidities that may obscure diagnosis; the importance of phenotyping; and the necessity of considering the patient experience in the diagnostic process.
AB - Although asthma is very common, affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world, which results in both over- and under-diagnosis. A taskforce was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendations for clinical practice. The taskforce defined eight Population, Index, Comparator and Outcome questions that were assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. The taskforce utilised the outcomes to develop an evidence-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences. The taskforce supports the initial use of spirometry followed by bronchodilator reversibility testing (if airway obstruction is present). If initial spirometry fails to show obstruction, further tests should be performed in the following order: exhaled nitric oxide fraction, peak expiratory flow variability, or, in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms. The taskforce reinforces spirometry as a priority and recognises the value of measuring blood eosinophils and serum immunoglobulin E to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved forced expiratory volume in 1 s/forced vital capacity ratio deserves further attention. The taskforce draws attention to the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids; the comorbidities that may obscure diagnosis; the importance of phenotyping; and the necessity of considering the patient experience in the diagnostic process.
U2 - 10.1183/13993003.01585-2021
DO - 10.1183/13993003.01585-2021
M3 - Review
C2 - 35169025
AN - SCOPUS:85127323876
VL - 60
JO - The European respiratory journal
JF - The European respiratory journal
SN - 0903-1936
IS - 3
M1 - 2101585
ER -
ID: 328692974