Pediatric asthma diagnosis: study suggests proposed UK algorithm is flawed

Access to the full content of this site is available only to registered healthcare professionals. Access to the full content of this site is available only to registered healthcare professionals.

Takeaway

  • 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.

Limitations

  • 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.