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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BMJ Publishing Group
2021
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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 |
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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 |
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