Approaches to Asthma Diagnosis in Children and Adults
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 th...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2019-04-01
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| Series: | Frontiers in Pediatrics |
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| Online Access: | https://www.frontiersin.org/article/10.3389/fped.2019.00148/full |
| _version_ | 1817993510866911232 |
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| author | Sejal Saglani Sejal Saglani Andrew N. Menzie-Gow Andrew N. Menzie-Gow |
| author_facet | Sejal Saglani Sejal Saglani Andrew N. Menzie-Gow Andrew N. Menzie-Gow |
| author_sort | Sejal Saglani |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-04-14T01:39:54Z |
| format | Article |
| id | doaj.art-eb53bfcb4b4749b1aeea7c2dd4fef55b |
| institution | Directory Open Access Journal |
| issn | 2296-2360 |
| language | English |
| last_indexed | 2024-04-14T01:39:54Z |
| publishDate | 2019-04-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Pediatrics |
| spelling | doaj.art-eb53bfcb4b4749b1aeea7c2dd4fef55b2022-12-22T02:19:48ZengFrontiers Media S.A.Frontiers in Pediatrics2296-23602019-04-01710.3389/fped.2019.00148431533Approaches to Asthma Diagnosis in Children and AdultsSejal Saglani0Sejal Saglani1Andrew N. Menzie-Gow2Andrew N. Menzie-Gow3National Heart & Lung Institute, Imperial College London, London, United KingdomDepartment of Respiratory Paediatrics, Royal Brompton Hospital, London, United KingdomNational Heart & Lung Institute, Imperial College London, London, United KingdomDepartment of Respiratory Medicine, Royal Brompton Hospital, London, United KingdomAlthough 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.https://www.frontiersin.org/article/10.3389/fped.2019.00148/fullasthma diagnosisspirometryexhaled nitric oxideguidelinesinflammationpaediatric asthma |
| spellingShingle | Sejal Saglani Sejal Saglani Andrew N. Menzie-Gow Andrew N. Menzie-Gow Approaches to Asthma Diagnosis in Children and Adults Frontiers in Pediatrics asthma diagnosis spirometry exhaled nitric oxide guidelines inflammation paediatric asthma |
| title | Approaches to Asthma Diagnosis in Children and Adults |
| title_full | Approaches to Asthma Diagnosis in Children and Adults |
| title_fullStr | Approaches to Asthma Diagnosis in Children and Adults |
| title_full_unstemmed | Approaches to Asthma Diagnosis in Children and Adults |
| title_short | Approaches to Asthma Diagnosis in Children and Adults |
| title_sort | approaches to asthma diagnosis in children and adults |
| topic | asthma diagnosis spirometry exhaled nitric oxide guidelines inflammation paediatric asthma |
| url | https://www.frontiersin.org/article/10.3389/fped.2019.00148/full |
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