The European Respiratory Society (ERS) has released its asthma diagnosis guidelines for adults in primary and secondary care settings.
“Although there are many asthma guidelines recommending objective testing to confirm the diagnosis in symptomatic patients, there is considerable variation between them with lack of consensus on the tests and their sequence. Yet, reports consistently reiterate the need to better diagnose asthma and the need to determine which of the commonly used tests are most helpful,” Renaud Louis, MD, PhD, of the department of pneumology at CHU Liege and the GIGA I3 Research Group at the University of Liege, Belgium, and colleagues wrote in the guidelines.
The guidelines resulted from the development of a taskforce set up by the ERS to “develop an evidence-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences” based on eight questions derived from the Population, Index, Comparator and Outcome (PICO) framework and evaluated using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) methodology.
“It is well recognised that adherence by healthcare professionals to guidelines is suboptimal, and this may reflect difficulty in access to the recommended tests or incorporating them in their everyday practice in diagnosing asthma within local patient pathways,” Louis, who is also a taskforce chair, and colleagues wrote. “Importantly, the patient’s perspective is often not taken into account at the planning stage when developing guidelines.”
ERS Taskforce Recommendations
Based on a literature search and applying the GRADE approach, the ERS taskforce made the following recommendations for diagnosing adults with asthma in everyday clinical practice:
A strong recommendation to use spirometry to identify airway obstruction for patients with suspected asthma as part of diagnostic work-up based on low quality of evidence.
A conditional recommendation against using peak expiratory flow variability testing as a primary diagnostic test for patients with suspected asthma based on low quality of evidence.
A conditional recommendation for including fractional exhaled nitric oxide measurements as part of diagnostic work-up for patients with asthma based on a moderate quality of evidence.
A conditional recommendation against measuring blood eosinophil count for diagnosing asthma in adults with episodic and/or chronic suggestive symptoms based on a low quality of evidence.
A conditional recommendation against measuring total serum immunoglobulin E to diagnose asthma in adults with episodic and/or chronic suggestive symptoms based on a low quality of evidence.
A conditional recommendation against combining fractional exhaled nitric oxide, blood eosinophils and serum immunoglobulin E to diagnose asthma in patients with episodic and/or chronic suggestive symptoms based on a moderate quality of evidence.
A conditional recommendation for performing bronchial challenge testing in secondary care for patients with episodic and/or chronic suggestive symptoms as a confirmation test in situations where a primary care setting did not confirm an asthma diagnosis based on a low quality of evidence.
A conditional recommendation against measuring specific airway conductance and residual volume/total lung capacity with whole-body plethysmography to diagnose patients who have episodic and/or chronic suggestive symptoms based on a low quality of evidence.
The taskforce acknowledged the low quality of evidence in many of the recommendations, citing the lack of well-designed studies and of a gold standard with which to evaluate asthma. “With this rapidly changing and evolving background, and on the basis of the literature searches performed, the taskforce highlights that a more nuanced and individualized diagnostic approach may be needed in the near future, to inform accurate prognostic and therapeutic clinical practice,” they concluded.
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Disclosures: Authors declared financial ties to drugmakers. See full study for details.
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