NICE issues draft guideline for asthma diagnosis

Thorley, Jennifer

doi:10.1016/s2213-2600(15)00038-7

Cited by 8 publications

(4 citation statements)

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“…As rhinitis may affect the patient's perception of asthma, it was recently suggested that the accuracy of the ACT has not been systematically evaluated [22]. In 2015, the UK National Institute for Health and Care Excellence (NICE) issued a draft guideline recommending use of spirometry first to improve the diagnosis of asthma [23]. While the guidelines recommend spirometry as the first-line investigation, asthma should not be followed up on the basis of any single diagnostic test.…”

Section: Resultsmentioning

confidence: 99%

Prospective Open-Label Study of 48-Week Subcutaneous Administration of Mepolizumab in Japanese Patients With Severe Eosinophilic Asthma

Kurosawa¹,

Sutoh²

2019

J Investig Allergol Clin Immunol

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Section: Resultsmentioning

confidence: 99%

Prospective Open-Label Study of 48-Week Subcutaneous Administration of Mepolizumab in Japanese Patients With Severe Eosinophilic Asthma

Kurosawa¹,

Sutoh²

2019

J Investig Allergol Clin Immunol

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“…An important change in the approach to diagnosis has recently been introduced in England, where the National Institute of Health and Care Excellence (NICE), whose purpose is to generate evidence based and cost effective guidelines, has recently been published [https://www.nice.org.uk/guidance/ng80]. It was claimed by NICE that up to 1.2 million of the approximately 4 million people with asthma in the UK were misdiagnosed and therefore being prescribed wrong or inappropriate medication (10). For the first time in England, it has now been recommended that both spirometry and exhaled nitric oxide tests should be used in all patients older than 5 years to help in the confirmation of the diagnosis.…”

Section: Incorporating Objective Tests To Make a Diagnosis Of Asthma:mentioning

confidence: 99%

Approaches to Asthma Diagnosis in Children and Adults

Saglani

Menzie-Gow

2019

Front. Pediatr.

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Although the hallmark features of asthma include reversible airflow obstruction, airway eosinophilia, and symptoms of recurrent wheeze associated with breathlessness and cough, it is a heterogeneous disease. The extent of the pathophysiological abnormalities are variable between patients. Despite this, until recently, asthma diagnosis had been made very simplistically predominantly from a clinical history and examination, and often a trial of medication such as short acting bronchodilators. The limitations of this approach have become increasingly apparent with evidence of inappropriate over diagnosis, under diagnosis and misdiagnosis. Although there is no gold standard single test to make a diagnosis of asthma, there are several objective tests that can be used to support the diagnosis including physiological measures such as obstructive spirometry associated with bronchodilator reversibility and airway hyperresponsiveness. In addition, non-invasive tests of airway inflammation such as exhaled nitric oxide or peripheral blood eosinophils are important to identify those with an allergic or eosinophilic phenotype. Diagnostic guidelines reflect the importance of using objective tests to support a diagnosis of asthma, however practical application in the clinic may not be straightforward. The focus of this review is to discuss the need to undertake objective tests in all patients to support asthma diagnosis and not just rely on clinical features. The advantages, challenges and limitations of performing tests of lung function and airway inflammation in the clinic, the difficulties related to training and interpretation of results will be explored, and the utility and relevance of diagnostic tests will be compared in adults and children.

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“…Namely, blood eosinophil count has been approved as a predictive biomarker for the efficacy of anti-IL-5 therapy in eosinophilic asthma patients [4], and blood eosinophil count was the first criterion. Based on the guideline by the UK National Institute for Health and Care Excellence, which has indicated to use spirometry first to improve diagnosis of asthma [5], an improvement of lung function presented the second treatment response criterion. As the third, we selected the ACT scoring [3].…”

mentioning

confidence: 99%

Unsustained Response to Benralizumab in Eosinophilic Asthma After 3 Years of Therapy With Mepolizumab

Kurosawa¹,

Shimizu²,

Sutoh³

et al. 2021

J Investig Allergol Clin Immunol

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Eosinophilic asthma. Forced expiratory volume in 1 second. Palabras clave: Terapia anti-interleukina 5. Test de control del asma. Recuento de eosinófilos en sangre. Asma eosinofílica. FEV1. Eosinophils play pivotal roles in the inflammatory processes of asthma, and have been the target of new biologic treatments for eosinophilic asthma. Benralizumab is the monoclonal antibody (mAb) that targets chain of the interleukin 5(IL-5) receptor, and mepolizumab is the anti-IL-5 mAb. We herein present a patient with eosinophilic asthma who showed un-sustained response to benralizumab after 3-year mepolizumab administration. A 42-year-old woman, never smoker, visited the clinic because of increasing dyspnea on January 22, 2016. She was treated with pranlukast 450mg/day and fluticasone/formoterol 125µg/5µg inhaler 2 puffs/day. Because of unstable respiratory symptoms, she was given systemic steroids occasionally. On February 27, 2016, the patient was introduced to the hospital by the experienced pulmonologist. We confirmed the diagnosis of asthma using the Global Initiative for Asthma guidelines [1].Forced expiratory volume in 1 second (FEV 1) was 74.1 % of the predicted value with an increase of 14.1 % in FEV 1 after 180µgsalbutamolinhaler. She was a non-allergic asthma patient, diagnosed with serum total IgE level 94 IU/mL and negative results of specific IgE for common inhaled allergens including Dermatophagoides farinae and pteronyssinus. Her regimen was changed to budesonide/formoterol160g/4.5g inhaler 8 puffs/day and montelukast10 mg/day. She stopped using systemic steroids, and daily use of the inhaler was reduced to 6 puffs/day on April 15.

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NICE issues draft guideline for asthma diagnosis

Cited by 8 publications

References 0 publications

Prospective Open-Label Study of 48-Week Subcutaneous Administration of Mepolizumab in Japanese Patients With Severe Eosinophilic Asthma

Prospective Open-Label Study of 48-Week Subcutaneous Administration of Mepolizumab in Japanese Patients With Severe Eosinophilic Asthma

Approaches to Asthma Diagnosis in Children and Adults

Unsustained Response to Benralizumab in Eosinophilic Asthma After 3 Years of Therapy With Mepolizumab

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