From the Guidelines
Asthma diagnosis is established by determining the presence of episodic symptoms of airflow obstruction or airway hyperresponsiveness, at least partially reversible airflow obstruction, and excluding alternative diagnoses.
Diagnostic Criteria
The diagnostic criteria for asthma according to the Global Initiative for Asthma (GINA) guidelines include:
- Episodic symptoms of airflow obstruction or airway hyperresponsiveness
- Airflow obstruction that is at least partially reversible, measured by spirometry, with an increase in FEV1 of >200 mL and 12% from baseline after inhalation of a short-acting β2-agonist (SABA) 1
- History of symptoms such as: + Cough (worse at night) + Recurrent wheeze + Recurrent difficulty in breathing + Recurrent chest tightness
- Symptoms that occur or worsen in the presence of specific triggers, such as: + Exercise + Viral infection + Inhalant allergens + Irritants + Changes in weather + Strong emotional expression + Stress + Menstrual cycles ### Diagnostic Methods Recommended methods to establish the diagnosis include:
- Detailed medical history
- Physical examination, focusing on the upper respiratory tract, chest, and skin
- Spirometry, which can demonstrate obstruction and assess reversibility in patients aged 5 years or older 1, 2 Note that a normal spirometry result does not exclude asthma, and additional studies may be necessary to exclude alternative diagnoses or identify other potential causes of symptoms 1, 2.
From the Research
Diagnostic Criteria for Asthma
The diagnostic criteria for asthma according to the Global Initiative for Asthma (GINA) guidelines are based on the level of disease control as a guide to treatment 3. The GINA guidelines classify asthma control into three categories:
- Well-controlled asthma
- Partly controlled asthma
- Uncontrolled asthma
Classification of Asthma Severity
The GINA guidelines have undergone several paradigm shifts since their establishment in 1993, including a shift from an opinion- to an evidence-based approach for the management of asthma severity in the late 1990s, and a shift to classifying asthma according to the level of control as a guide to treatment in 2006 4, 3.
Assessment of Asthma Control
Several tools are available to assess asthma control in children, including the Childhood Asthma Control Test (C-ACT) and the GINA guideline-based asthma control measure (ACM) 5. The C-ACT scores and GINA guideline-based ACM are positively correlated, and the GINA guideline-based ACM is correlated with spot spirometry parameters such as forced vital capacity, forced expiratory volume in 1 second, and maximal mid-expiratory flow 5.
Comparison of Asthma Control Measures
Studies have compared the correlations between different asthma control measures in children, including the C-ACT, GINA guideline-based ACM, and Pediatric Asthma Quality of Life Questionnaire (PAQLQ) 6. The results show that the Asthma Control Test (ACT) exhibits higher comparability with GINA than the Pediatric Asthma Control Test (PACT) and PAQLQ, and that PAQLQ has higher agreement with GINA criteria in children aged 12 years and older 6.
Recent Updates to Asthma Guidelines
Recent updates to asthma guidelines, including the National Asthma Education and Prevention Program (NAEPP) 2020 and GINA 2021, provide evidence-based recommendations for asthma diagnosis and treatment 7. These guidelines offer a framework for healthcare providers to provide the best and most updated asthma care to their patients.