Priorities for future research into asthma diagnostic tools: A PAN‐EU consensus exercise from the European asthma research innovation partnership (EARIP)

Abstract

The diagnosis of asthma is currently based on clinical history, physical examination and lung function, and to date, there are no accurate objective tests either to confirm the diagnosis or to discriminate between different types of asthma. This consensus exercise reviews the state of the art in asthma diagnosis to identify opportunities for future investment based on the likelihood of their successful development, potential for widespread adoption and their perceived impact on asthma patients. Using a two-stage e-Delphi process and a summarizing workshop, a group of European asthma experts including health professionals, researchers, people with asthma and industry representatives ranked the potential impact of research investment in each technique or tool for asthma diagnosis and monitoring. After a systematic review of the literature, 21 statements were extracted and were subject of the two-stage Delphi process. Eleven statements were scored 3 or more and were further discussed and ranked in a face-to-face workshop. The three most important diagnostic/predictive tools ranked were as follows: "New biological markers of asthma (eg genomics, proteomics and metabolomics) as a tool for diagnosis and/or monitoring," "Prediction of future asthma in preschool children with reasonable accuracy" and "Tools to measure volatile organic compounds (VOCs) in exhaled breath."

Monitoring of respiratory resistance in the diagnosis of mild intermittent asthma

“…Therefore, it appears logical to use indexes of lung function variability over multiple days as objective tools for confirming the diagnosis of asthma and monitor its severity. 10 In the present study, we confirmed that daily self-administered Even though further validation studies are warranted, these results support the view that FOT may become an accurate and rapid tool to document day-to-day variability of airway obstruction, thus possibly representing an additional diagnostic tool for asthma.…”

The efficacy of the combination of exhaled nitric oxide and blood eosinophil count in the diagnosis of asthma in China

“…[6] The BPT is time consuming, has a risk of triggering asthma attack, and is generally not available in primary care; the BDT has limited value for distinguishing asthma from chronic airway diseases; and variable peak expiratory ow requires good cooperation and adherence. [26][27][28] Conspicuously, the UK National Institute for Health and Care Excellence (NICE) recommends that FeNO, a potential indirect predictor of Th2 airway in ammation in asthma, should be measured in all suspected asthma patients. [29] Our data indicated that the optimal cutoff level for FeNO in the diagnosis of asthma was 38 ppb, in line with the recommendation by Japanese Respiratory Society (JRS), [30] who recommend using a FeNO cutoff value of 35 ppb to diagnose asthma.…”

“…[31,32] Therefore, many guidelines recommend that FeNO should be combined with other objective evidence to identify in ammatory respiratory diseases. [1,26,29,33] B-Eos count, another promising and easy-to-measure biomarker, is more attractive as a means of diagnosing asthma. [6,34] In this study, we found that the optimal diagnostic cutoff level was 203 cells/µl for B-Eos to identify asthma.…”

Special Considerations in Preschool Age

“…Concerns arise from generalizability of questions, absence of a global standard diagnosing system for childhood asthma, and validity of the models. Any efforts aimed at constructing models and predictive indices for asthma should address external validity and meticulously identify predictors that are previously identified risk factors from epidemiological studies to correctly describe and predict future asthma -albeit they are predictors from clinical examinations, questionnaires, lung function tests, or biomarker measurements [148].…”