Diagnostic work-up in patients with possible asthma referred to a university hospital

Vibeke Backer, Asger Sverrild, Charlotte Suppli Ulrik, Uffe Bødtger, Niels Seersholm, Celeste Porsbjerg

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Abstract

OBJECTIVE: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.

METHODS: All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.

RESULTS: Of the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%.

CONCLUSION: In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).

Original languageEnglish
Article number27768
JournalEuropean Clinical Respiratory Journal
Volume2
Number of pages8
ISSN2001-8525
DOIs
Publication statusPublished - 2015

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Methacholine Chloride
Routine Diagnostic Tests
Peak Expiratory Flow Rate
Ambulatory Care Facilities
Population

Keywords

  • asthma
  • Severe asthma
  • Diagnose
  • Difficult-to-treat asthma

Cite this

Backer, Vibeke ; Sverrild, Asger ; Ulrik, Charlotte Suppli ; Bødtger, Uffe ; Seersholm, Niels ; Porsbjerg, Celeste. / Diagnostic work-up in patients with possible asthma referred to a university hospital. In: European Clinical Respiratory Journal. 2015 ; Vol. 2.
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abstract = "OBJECTIVE: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.METHODS: All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.RESULTS: Of the 190 individuals examined, 63{\%} (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13{\%}, whereas airway hyperresponsiveness to methacholine had the highest (69{\%}). In contrast, specificity was the highest for reversibility testing (93{\%}), whereas methacholine had the lowest specificity (57{\%}). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78{\%}, albeit a specificity of 41{\%}. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82{\%} and a sensitivity of 42{\%}.CONCLUSION: In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).",
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Diagnostic work-up in patients with possible asthma referred to a university hospital. / Backer, Vibeke; Sverrild, Asger; Ulrik, Charlotte Suppli; Bødtger, Uffe; Seersholm, Niels; Porsbjerg, Celeste.

In: European Clinical Respiratory Journal, Vol. 2, 27768, 2015.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Diagnostic work-up in patients with possible asthma referred to a university hospital

AU - Backer, Vibeke

AU - Sverrild, Asger

AU - Ulrik, Charlotte Suppli

AU - Bødtger, Uffe

AU - Seersholm, Niels

AU - Porsbjerg, Celeste

PY - 2015

Y1 - 2015

N2 - OBJECTIVE: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.METHODS: All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.RESULTS: Of the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%.CONCLUSION: In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).

AB - OBJECTIVE: The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.METHODS: All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.RESULTS: Of the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%.CONCLUSION: In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).

KW - asthma

KW - Severe asthma

KW - Diagnose

KW - Difficult-to-treat asthma

U2 - 10.3402/ecrj.v2.27768

DO - 10.3402/ecrj.v2.27768

M3 - Journal article

C2 - 26557251

VL - 2

JO - European Clinical Respiratory Journal

JF - European Clinical Respiratory Journal

SN - 2001-8525

M1 - 27768

ER -