The TF draw attention on the difficulty of making a correct diagnosis in patients already receiving inhaled corticosteroids, the comorbidities that may obscure the diagnosis, the importance of phenotyping, and the necessity to consider the patient experience in the diagnostic process.Ībbreviations AUC-ROC Area under the receiver operating characteristic curve BdR Bronchodilator reversibility BEC Blood eosinophil count BHR Bronchial hyperresponsiveness CI Confidence intervals COPD Chronic obstructive pulmonary disease EtD Evidence to decision framework FeNO Forced exhaled nitric oxide FEV 1 Forced expiratory volume in one second FRC Functional residual capacity GINA Global Initiative for Asthma GRADE Grading of Recommendations, Assessment, Development and Evaluation HRCT High resolution computed tomogram ICS Inhaled corticosteroid IgE Immunoglobulin E IL Interleukin NPV Negative predictive value OCS Oral corticosteroid PC20-H Provocation concentration causing 20% fall in FEV 1 with histamine PC20-M Provocation concentration causing 20% fall in FEV 1 with methacholine PD15 Provocation dose causing a 15% fall in FEV 1 PEF Peak expiratory flow PICO Population, Index (Test), Comparison and Outcome PPV Positive predictive value PRISMA Preferred Reporting Items for Systematic reviews and Meta-Analyses ROC Receiver operating characteristic RV Residual volume SABA Short-acting beta-2 agonist sGAW Specific airway conductance TF Task force TLC Total lung capacityĪsthma is the most frequent chronic inflammatory airway disease globally with a prevalence reaching 5–10%, affecting 339 million people worldwide. Measuring gas trapping by body plethysmography in patients with preserved FEV 1/FVC ratio deserves further attention. The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences. A task force (TF) 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 recommendation for clinical practice. Although asthma is very common affecting 5–10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis.
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