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NICE recommends raft of tests to improve asthma diagnosis

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A series of clinical tests, starting with spirometry, should be used to help support a diagnosis of asthma, according to draft guidance from the National Institute for Health and Care Excellence.

It has issued a draft guideline to set out the most effective way to diagnose asthma and how healthcare professionals can help adults, children and young people better control their symptoms.

Roughly 1.2 million adults in the UK may be wrongly diagnosed with asthma, according to the institute. In total, over 4.1 million people in the UK are currently receiving treatment for asthma, but studies show that almost 30% of adults supposedly with the condition do not have clear evidence of it.

Some patients may have had asthma in the past, especially as children, but it is likely that many have also been given an incorrect diagnosis, said NICE in its draft guidance.

Professor Mark Baker, director of clinical practice at NICE said: “Accurate diagnosis of asthma has been a significant problem which means that people may be wrongly diagnosed or cases might be missed in others.

“Our aim with this guideline is to give clarity and set out the most clinical and cost effective ways to diagnose and monitor asthma based on the best available evidence,” he said.

NICE noted that there was currently no “gold standard” test to diagnose asthma and in current practice healthcare professionals mainly check for signs and symptoms, including breathlessness, coughing, wheezing and tightness in the chest.

The guideline, published today for consultation, stresses that to achieve an accurate diagnosis clinical tests should be used as well as checking for signs and symptoms.

“Our aim with this guideline is to give clarity and set out the most clinical and cost effective ways to diagnose and monitor asthma”

Mark Baker

The process that the healthcare professional should follow in the initial assessment, and the tests to use, are presented in the guidance as simple flow charts.

The first test should be carried out using a spirometer. Further breath tests should be carried out depending on the results from spirometry and the patient’s age.

For adults and young people over five years, tests include checking for levels of nitric oxide (FeNO test3) and whether standard medicines that widen the airways of the lung are of benefit (BDR test4).

The treatment of under-fives should be based on professional judgement and observation until the child is old enough to take clinical tests, said the guidance.

The draft guideline also recommends that healthcare professionals should ask employed people how their symptoms are affected by work to check if they may have occupational asthma.

Other key priorities include monitoring how well a patient is controlling their symptoms. The draft guideline states that during each review healthcare professionals should check that the patient is able to use their inhaler correctly and also consider using a validated questionnaire so they get a better estimate of how well a patient is doing.

Professor Baker said: “This new draft guideline provides advice for primary, secondary and community care healthcare professionals on the most suitable tests for accurately diagnosing asthma and how to help people monitor and control their symptoms.

“We now want to hear from all those who provide care for people with asthma in the NHS to ensure all relevant views are considered for the final guideline,” he added.

In a statement responding to the guidance, the charity Asthma UK said: “Asthma has many complex causes, which is why it is sometimes difficult to get a definitive diagnosis.

“It’s also a hugely variable condition that can change throughout someone’s life or even week by week, meaning treatment can change over time.”

Rebecca Sherrington of the Association of Respiratory Nurse Specialists, said:

“Asthma is a condition which can be hard to diagnose and without a single absolute test to diagnose, research has shown that under diagnosis and under treatment is a problem. 

I support the NICE recommendations, although I appreciate that the tests aren’t at the moment widely available, so a investment in training and equipment will be needed in both primary and secondary care.  I believe that this guidance supports better diagnosis and personalised asthma care.”

 

Read the full NICE guidance here

 

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Readers' comments (2)

  • This is all very well and may prove another effective tool to diagnose and manage asthma, however as an Asthma Nurse in primary care we are all encouraged to follow the BTS guidelines which indeed follow most if not all of the above proposed plans. Spirometry may indeed prove an effective tool but time doesn't always allow for this and the equipment and skill set of nurses might not be available at all GP practices. I might also add that under the BTS guidelines 2014, at present children under the age of 7 need to be assessed for asthma from clinical diagnosis, as PFR and indeed spirometry tests might well prove inconclusive due to the variability of readings from poor technique in the younger child.

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  • I just like to know the practicalities of doing all these tests, for instance health care professionals are more or less going to have to be trained up a respiratory technicians , spirometry should only be done by people who has been proved to be compitant following the ARTPS course

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