- Poor agreement between algorithm and epidemiological definition of pediatric asthma suggests an urgent need for more evidence about diagnostic tests.
Why this matters
- Until better evidence is available, the UK National Institute of Health and Care Excellence (NICE)-proposed new asthma diagnostic algorithm should not be implemented in children.
- An editorial accompanies the report.
- Data from prospective Manchester Asthma and Allergy Study.
- Follow-up of birth cohort at age 13-16 y.
- Test of the NICE algorithm, based on 4 measures of lung function, against epidemiological definition of current asthma, defined as all 3 of physician-diagnosed asthma, current wheeze, and current use of asthma treatment, reported by parents in a validated questionnaire.
- Funding: UK Medical Research Council.
- 772 children.
- Poor agreement between algorithm and epidemiological definition of current asthma.
- Findings challenge the algorithm’s spirometry cutoff values, order of tests, and position of bronchodilator reversibility within the algorithm sequence.
- Study relied on a physician diagnosis of asthma, without details of how this was ascertained.
- Lung function measurements taken at routine visits, without waiting until child was symptomatic.
- Peak flow variability was not measured.