Abstract
Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.
A Task Force (TF) supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years using nine PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
The TF then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The TF formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of interest: Dr. Gaillard reports and Consultancy work for Boehringer Ingelheim with money paid to the institution (University of Leicester). Investigator led research grant from Circassia, Gilead and Chiesi limited. Research collaboration with Medimmune.
Conflict of interest: Dr. Kuehni has nothing to disclose.
Conflict of interest: Dr. Turner has nothing to disclose.
Conflict of interest: Dr. Goutaki has nothing to disclose.
Conflict of interest: Dr. Holden has nothing to disclose.
Conflict of interest: Dr. de Jong has nothing to disclose.
Conflict of interest: Dr. Lex reports other from Novartis, outside the submitted work; .
Conflict of interest: Dr. Lo has nothing to disclose.
Conflict of interest: Dr. Lucas reports grants and non-financial support from Circassia, outside the submitted work; .
Conflict of interest: Dr. Midulla has nothing to disclose.
Conflict of interest: Dr. Mozun has nothing to disclose.
Conflict of interest: Dr. Piacentini has nothing to disclose.
Conflict of interest: Dr. Rigau reports and declares he was one of the ERS methodologists.
Conflict of interest: Dr. Rottier has nothing to disclose.
Conflict of interest: Dr. Thomas reports personal fees from GSK, personal fees from Boehringer Ingelheim, personal fees from Chiesi, outside the submitted work; .
Conflict of interest: Ms Tonia reports acting as ERS Methodologist .
Conflict of interest: Dr. Usemann reports personal fees from Vertex, outside the submitted work; .
Conflict of interest: Dr. Yilmaz reports non-financial support from Abdi Ibrahim , other from Novartis, outside the submitted work; .
Conflict of interest: Dr. Zacharasiewicz has nothing to disclose.
Conflict of interest: Dr. Moeller has nothing to disclose.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received November 12, 2020.
- Accepted March 15, 2021.
- Copyright ©The authors 2021. For reproduction rights and permissions contact permissions{at}ersnet.org
