From the Research
Current guidelines from the American Academy of Pediatrics (AAP), Global Initiative for Asthma (GINA), and National Heart, Lung, and Blood Institute (NHLBI) do not recommend routine laboratory tests or chest X-rays for typical asthma presentations. These guidelines specifically advise against obtaining complete blood counts, basic metabolic panels, or chest radiographs in patients presenting with characteristic asthma symptoms without concerning features. The most recent and highest quality study, 1, published in 2024, supports this recommendation, as it emphasizes the importance of history, physical examination, and spirometry in diagnosing asthma.
Key Points to Consider
- Asthma is primarily a clinical diagnosis based on history, physical examination, and spirometry when appropriate 1.
- Routine laboratory tests and imaging add cost, potential radiation exposure, and rarely change management in straightforward asthma cases.
- Diagnostic testing should be reserved for cases where there are atypical features, poor response to therapy, or suspicion of complications or alternative diagnoses.
- Incidental findings from routine laboratory tests and imaging may lead to unnecessary follow-up testing and patient anxiety.
Recommendations for Practice
- Clinicians should focus on thorough history-taking, physical examination, and assessment of response to bronchodilator therapy, which are more valuable for diagnosis and management of uncomplicated asthma 2.
- The combination of symptoms, including wheezing, breathlessness, chest tightness, and cough, can aid in early diagnosis, as reported in 3.
- A working understanding of asthma's definition, pathophysiology, and subtypes is essential for providers to manage patients with chronic nasal or sinus inflammation effectively 4.