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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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Autores principales: Saglani, Sejal, Menzie-Gow, Andrew N.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478800/
https://www.ncbi.nlm.nih.gov/pubmed/31058123
http://dx.doi.org/10.3389/fped.2019.00148
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author Saglani, Sejal
Menzie-Gow, Andrew N.
author_facet Saglani, Sejal
Menzie-Gow, Andrew N.
author_sort Saglani, Sejal
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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.
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spelling pubmed-64788002019-05-03 Approaches to Asthma Diagnosis in Children and Adults Saglani, Sejal Menzie-Gow, Andrew N. Front Pediatr Pediatrics 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. Frontiers Media S.A. 2019-04-17 /pmc/articles/PMC6478800/ /pubmed/31058123 http://dx.doi.org/10.3389/fped.2019.00148 Text en Copyright © 2019 Saglani and Menzie-Gow. http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pediatrics
Saglani, Sejal
Menzie-Gow, Andrew N.
Approaches to Asthma Diagnosis in Children and Adults
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 Pediatrics
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6478800/
https://www.ncbi.nlm.nih.gov/pubmed/31058123
http://dx.doi.org/10.3389/fped.2019.00148
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