Pediatric asthma diagnosis: study suggests proposed UK algorithm is flawed

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  • 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.

Study design

  • 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.

Key results

  • 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.