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European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years

journal contribution
posted on 2022-05-23, 12:01 authored by Erol A Gaillard, Claudia E Kuehni, Steve Turner, Myrofora Goutaki, Karl A Holden, Carmen CM de Jong, Christiane Lex, David KH Lo, Jane S Lucas, Fabio Midulla, Rebeca Mozun, Giorgio Piacentini, David Rigau, Bart Rottier, Mike Thomas, Thomy Tonia, Jakob Usemann, Ozge Yilmaz, Angela Zacharasiewicz, Alexander Moeller

Background 

Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children.


Methods 

A task force 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 Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.


Results 

The task force 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 task force formulated recommendations using the GRADE Evidence to Decision framework.


Conclusion 

Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force 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.

Funding

European Respiratory Society (grant: task force-2017-06).

History

Citation

European Respiratory Journal 2021 58: 2004173; DOI: 10.1183/13993003.04173-2020

Author affiliation

Department of Respiratory Sciences, University of Leicester

Version

  • AM (Accepted Manuscript)

Published in

European Respiratory Journal

Volume

58

Issue

5

Publisher

European Respiratory Society

issn

0903-1936

eissn

1399-3003

Acceptance date

2021-03-15

Copyright date

2021

Available date

2022-11-04

Spatial coverage

England

Language

English

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