Cargando…

Asthma diagnosis: into the fourth dimension

Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic...

Descripción completa

Detalles Bibliográficos
Autores principales: Wang, Ran, Murray, Clare S, Fowler, Stephen J, Simpson, Angela, Durrington, Hannah Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223645/
https://www.ncbi.nlm.nih.gov/pubmed/33504564
http://dx.doi.org/10.1136/thoraxjnl-2020-216421
_version_ 1783711734449569792
author Wang, Ran
Murray, Clare S
Fowler, Stephen J
Simpson, Angela
Durrington, Hannah Jane
author_facet Wang, Ran
Murray, Clare S
Fowler, Stephen J
Simpson, Angela
Durrington, Hannah Jane
author_sort Wang, Ran
collection PubMed
description Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the ‘positive’ and ‘negative’ outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis.
format Online
Article
Text
id pubmed-8223645
institution National Center for Biotechnology Information
language English
publishDate 2021
publisher BMJ Publishing Group
record_format MEDLINE/PubMed
spelling pubmed-82236452021-07-09 Asthma diagnosis: into the fourth dimension Wang, Ran Murray, Clare S Fowler, Stephen J Simpson, Angela Durrington, Hannah Jane Thorax State of the Art Review Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the ‘positive’ and ‘negative’ outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis. BMJ Publishing Group 2021-06 2021-01-27 /pmc/articles/PMC8223645/ /pubmed/33504564 http://dx.doi.org/10.1136/thoraxjnl-2020-216421 Text en © Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle State of the Art Review
Wang, Ran
Murray, Clare S
Fowler, Stephen J
Simpson, Angela
Durrington, Hannah Jane
Asthma diagnosis: into the fourth dimension
title Asthma diagnosis: into the fourth dimension
title_full Asthma diagnosis: into the fourth dimension
title_fullStr Asthma diagnosis: into the fourth dimension
title_full_unstemmed Asthma diagnosis: into the fourth dimension
title_short Asthma diagnosis: into the fourth dimension
title_sort asthma diagnosis: into the fourth dimension
topic State of the Art Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8223645/
https://www.ncbi.nlm.nih.gov/pubmed/33504564
http://dx.doi.org/10.1136/thoraxjnl-2020-216421
work_keys_str_mv AT wangran asthmadiagnosisintothefourthdimension
AT murrayclares asthmadiagnosisintothefourthdimension
AT fowlerstephenj asthmadiagnosisintothefourthdimension
AT simpsonangela asthmadiagnosisintothefourthdimension
AT durringtonhannahjane asthmadiagnosisintothefourthdimension