From the Guidelines
Diagnostic Criteria for Adult Asthma
The Global Initiative for Asthma (GINA) diagnostic criteria for adult asthma require a compatible clinical history and objectively confirmed variable expiratory airflow limitation on lung function testing 1.
- The diagnosis is based on a combination of clinical symptoms and objective measures of lung function.
- The GINA report recommends five methods to objectively confirm excessive variability in lung function, including:
- A positive bronchodilator responsiveness test with spirometry
- Excessive variability in twice-daily peak expiratory flow (PEF) measurements over 2 weeks
- Increase in lung function following 4 weeks of treatment with inhaled corticosteroid (ICS)
- Positive bronchial challenge test
- Excessive variation in lung function between visits 1.
- Objective lung function measurements are necessary to confirm an asthma diagnosis, with pulmonary function tests (PFTs) such as spirometry showing reversible airflow obstruction or challenge tests showing increased airway sensitivity being the gold-standard objective measures 1.
- For patients already on an ICS-containing medication, the GINA report recommends repeating objective lung function measures and trialling a step-down of ICS-containing treatment to confirm a diagnosis 1.
From the Research
Diagnostic Criteria for Adult Asthma
The diagnostic criteria for adult asthma according to the Global Initiative for Asthma (GINA) are not explicitly stated in the provided studies. However, the following points can be inferred:
- GINA recommends confirming the diagnosis of asthma using spirometry or peak expiratory flow 2.
- The diagnosis of asthma-COPD overlap syndrome (ACOS) is somewhat complicated, and limited data are available regarding how ACOS patients respond to current medications 3.
- GINA guidance is adopted by national asthma guidelines in many countries, adapted to fit local healthcare systems, practices, and resource availability 2.
Key Recommendations for Asthma Diagnosis
Some key recommendations for asthma diagnosis include:
- Achieving overall asthma control is the goal of therapy, which consists of 2 domains: to achieve day-to-day (or current) asthma control and to minimize future risk measured by the absence of asthma exacerbations, the prevention of accelerated decline in lung function over time, and no side effects from medications 4.
- GINA recommends individualized assessment, adjustment, and review of treatment 2.
- The GINA treatment paradigm consists of 5 treatment steps, with a preferred option and other alternatives identified at each step 4.
Asthma Management
Asthma management according to GINA includes:
- Inhaled corticosteroid (ICS)-containing therapy to reduce the risk of severe exacerbations, either taken regularly or as combination ICS-formoterol taken as needed for symptom relief 2.
- Maintenance-and-reliever therapy (MART) with ICS-formoterol for patients with moderate-severe asthma 2.
- Severe asthma is recognized as a major unmet need in the management of asthma, and a considerable proportion of patients have uncontrolled asthma while on current GINA steps 4-5 treatment 5.