Erol A. Gaillard, Claudia E. Kuehni, Steve Turner, Myrofora Goutaki, Karl A. Holden, Carmen C.M. de Jong, Christiane Lex, David K.H. 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
European Respiratory Journal 2021; DOI: 10.1183/13993003.04173-2020
Abstract
Diagnosing asthma in children represents an important clinical challenge. There is no single gold standard test to confirm the diagnosis. Consequently, both over-, and under-diagnosis of asthma are frequent in children.
A Task Force (TF) 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 PICO (Population, Intervention, Comparator and Outcome) questions. The TF conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full text articles. All TF members approved the final decision for inclusion of research papers. The TF assessed the quality of the evidence using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach.
The TF 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 TF formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision Framework the TF recommends spirometry, bronchodilator reversibility testing and FeNO as first line diagnostic tests in children under investigation for asthma. The TF 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.