European Respiratory Society guidelines for the diagnosis of asthma in adults

Publikation: Bidrag til tidsskriftReviewForskningfagfællebedømt

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  • Renaud Louis
  • Imran Satia
  • Inigo Ojanguren
  • Florence Schleich
  • Matteo Bonini
  • Thomy Tonia
  • David Rigau
  • Anne ten Brinke
  • Roland Buhl
  • Stelios Loukides
  • Janwillem W. H. Kocks
  • Louis-Philippe Boulet
  • Arnaud Bourdin
  • Courtney Coleman
  • Karen Needham
  • Mike Thomas
  • Marco Idzko
  • Alberto Papi
  • Daniel Schuermans
  • Joan B. Soriano
  • Omar S. Usmani

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.

OriginalsprogEngelsk
Artikelnummer2101585
TidsskriftEuropean Respiratory Journal
Vol/bind60
Udgave nummer3
Antal sider25
ISSN0903-1936
DOI
StatusUdgivet - 2022

Bibliografisk note

Funding Information:
Conflict of interest: R. Louis reports grants and personal fees from GSK, AZ, Chiesi and Novartis, personal fees from Sanofi, outside the submitted work. I. Satia reports grants and personal fees from GSK and Merck, personal fees from AstraZeneca, grants from ERS Respire 3 Marie Curie Fellowship and E.J. Moran Campbell Early Career Award, outside the submitted work. I. Ojanguren reports grants and personal fees from AstraZeneca, Sanofi and GSK, personal fees and non-financial support from Boehringer Ingelheim and Chiesi, grants, personal fees and non-financial support from Novartis, personal fees from MSD, Puretech, Bial and TEVA, outside the submitted work. F. Schleich reports grants and personal fees for national board participation and presentations from GSK and AstraZeneca, personal fees for board participation and lectures from Chiesi, outside the submitted work. M. Bonini has nothing to disclose. T. Tonia reports acting as ERS Methodologist. D. Rigau worked as ERS methodologist until February 2020. A. ten Brinke reports institutional fees for research advisory board work from GSK, Sanofi, TEVA, AstraZeneca and Boehringer Ingelheim, institutional fees for lectures from AstraZeneca, GSK, TEVA and SanofiGenzyme, grants from AstraZeneca, GSK and TEVA, outside the submitted work. R. Buhl reports personal fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Novartis, Sanofi, Roche and Teva, and grants to Mainz University Hospital from Boehringer Ingelheim, GlaxoSmithKline, Novartis and Roche, all outside the submitted work. S. Loukides has nothing to disclose. J.W.H. Kocks reports grants, institutional fees and non-financial support from AstraZeneca and Boehringer Ingelheim, grants and institutional fees from Chiesi Pharmaceuticals, GSK, Novartis and TEVA, institutional fees from MSD and COVIS, outside the submitted work; and holds 72.5% of shares in the General Practitioners Research Institute. L-P. Boulet reports grants from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis and Sanofi-Regeneron, personal fees for consultancy and advisory board work from AstraZeneca, Novartis, GlaxoSmithKline, Merck and Sanofi-Regeneron, personal fees for lectures from AstraZeneca, Covis, GlaxoSmithKline, Novartis, Merck and Sanofi, grants and non-financial support from AstraZeneca, Covis, GlaxoSmithKline, Merck and Novartis, and is Chair of Global Initiative for Asthma (GINA) Board of Directors, President of the Global Asthma Organisation (Interasma) and Member of the Canadian Thoracic Society Respiratory Guidelines Committee. A. Bourdin reports grants, personal fees, non-financial support and other (investigator in clinical trials) from GSK, AstraZeneca, Boeringher Ingelheim and Actelion/Jansen, personal fees, non-financial support and other (investigator in clinical trials) from Novartis, Chiesi Farma, Sanofi Regeneron and Roche, non-financial support and other (investigator in clinical trials) from Teva, other (investigator in clinical trials) from United Therapeutics and Pulsar, outside the submitted work. C. Coleman is an employee of European Lung Foundation. K. Needham has nothing to disclose. M. Thomas reports personal fees from GSK, Boehringer Ingelheim and Chiesi, outside the submitted work. M. Idzko has nothing to disclose. A. Papi reports board membership, consultancy, payment for lectures, grants for research and travel expenses reimbursement from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici and TEVA, board membership, consultancy, payment for lectures and travel expenses reimbursement from Mundipharma, Zambon, Novartis and Sanofi/Regeneron, grants for research, payment for lectures and travel expenses reimbursement from Menarini, board membership, consultancy and travel expenses reimbursement from Roche, grants from Fondazione Maugeri and Fondazione Chiesi, personal fees for consultancy from Edmondpharma, outside the submitted work. C. Porsbjerg reports grants and personal fees from Astra Zeneca, GSK, Novartis, TEVA, Sanofi and Chiesi, grants from Pharmaxis, outside the submitted work. D. Schuermans reports non-financial support from Free University of Brussels, outside the submitted work. J.B. Soriano has nothing to disclose. O.S. Usmani reports grants and personal fees from AstraZeneca, Boehringer Ingelheim, Chiesi and GlaxoSmithKline, grants from Edmond Pharma, personal fees from Napp, Mundipharma, Sandoz, Takeda, Cipla, Covis, Novartis, Mereo Biopharma, Orion, Menarini, Ucb, Trudell Medical, Deva and Kamada, outside the submitted work.

Funding Information:
Support statement: This study was supported by the European Respiratory Society. Funding information for this article has been deposited with the Crossref Funder Registry.

Publisher Copyright:
Copyright © The authors 2022.

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