Don’t initiate medications for asthma (e.g., inhalers, leukotriene receptor antagonists, or other) in patients ≥ 6 years old who have not had confirmation of reversible airflow limitation with spirometry, and in its absence, a positive methacholine or exercise challenge test, or sufficient peak expiratory flow variability.

Although international guidelines uniformly recommend objective testing to establish an asthma diagnosis, this diagnosis is often made clinically and asthma medications are often initiated on that clinical basis. However, physical exam findings and symptoms such as cough, wheeze, and/or dyspnea can be caused by other conditions. As a result, up to one third of patients who have been diagnosed with asthma do not have evidence of asthma when objectively tested with pulmonary function tests. A false clinical diagnosis of asthma may delay diagnosis of the actual underlying condition, which may include serious cardiorespiratory conditions. Furthermore, patients with a false diagnosis of asthma who are started on asthma medications are unnecessarily exposed to both the side-effects and the costs of these medications. It should be noted, however, that this recommendation may not be applicable in patients who cannot reproducibly undergo objective testing for asthma (including children less than 6 years old), and in settings where such testing is not available.

 

Sources:

Aaron SD, et al. Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. 2017 Jan 17;317(3):269-279. PMID: 28114551.

British Thoracic Society/Scottish Intercollegiate Guidelines Network. BTS/SIGN British guideline on the management of asthma [Internet]. 2017 Apr [cited 2017 May 5].

Global Initiative for Asthma. 2017 GINA Report, Global Strategy for Asthma Management and Prevention [Internet]. 2017 [cited 2017 May 5].

Lougheed MD, et al. Canadian Thoracic Society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can Respir J. 2012 Mar-Apr; 19(2): 127–164.