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

Backer V, Sverrild A, Ulrik CS, Bødtger U, Seersholm N, Porsbjerg C - Eur Clin Respir J (2015)

Bottom Line: 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%.

View Article: PubMed Central - PubMed

Affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.

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).

No MeSH data available.


Related in: MedlinePlus

Flow-chart of the MapOut II study.
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Figure 0001: Flow-chart of the MapOut II study.

Mentions: This is a cross-sectional study of individuals with possible asthma referred to the respiratory outpatient clinic at Bispebjerg University hospital, Copenhagen, Denmark. This group of patients is unselected and represent asthma patient referred to a university hospital. The participants were consecutively enrolled over 12 months (May 2012 to April 2013) (Fig. 1). Exclusion criteria were respiratory diseases other than asthma (e.g. sarcoidosis, chronic obstructive pulmonary disease (COPD)), children younger than 15 years, individuals older than 40 years with a smoking history of more than 10 pack-years, pregnancy, and recent respiratory infection (<6 weeks). All participants were assessed with a 3-day asthma evaluation program (Table 1): (V1) interview and reversibility test; (V2) methacholine provocation test, skin prick test, and asthma control questionnaire (ACQ); (V3) fractional exhaled nitric oxide (FeNO), mannitol provocation, and peak expiratory flow (PEF) diary. A specialist panel evaluated the diagnosis of asthma based on symptoms, family history of atopy, and baseline lung function. The specialist diagnosis of asthma was used to evaluate the diagnostic value of reversibility to β2-agonist (>200 mL and 12%), PEF variation (>20%), and AHR to methacholine (PD20<7.8 µmol) or AHR to mannitol (PD15<635 mg). The study was approved by the local ethics committee (H-3-2011-121).


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

Backer V, Sverrild A, Ulrik CS, Bødtger U, Seersholm N, Porsbjerg C - Eur Clin Respir J (2015)

Flow-chart of the MapOut II study.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4629726&req=5

Figure 0001: Flow-chart of the MapOut II study.
Mentions: This is a cross-sectional study of individuals with possible asthma referred to the respiratory outpatient clinic at Bispebjerg University hospital, Copenhagen, Denmark. This group of patients is unselected and represent asthma patient referred to a university hospital. The participants were consecutively enrolled over 12 months (May 2012 to April 2013) (Fig. 1). Exclusion criteria were respiratory diseases other than asthma (e.g. sarcoidosis, chronic obstructive pulmonary disease (COPD)), children younger than 15 years, individuals older than 40 years with a smoking history of more than 10 pack-years, pregnancy, and recent respiratory infection (<6 weeks). All participants were assessed with a 3-day asthma evaluation program (Table 1): (V1) interview and reversibility test; (V2) methacholine provocation test, skin prick test, and asthma control questionnaire (ACQ); (V3) fractional exhaled nitric oxide (FeNO), mannitol provocation, and peak expiratory flow (PEF) diary. A specialist panel evaluated the diagnosis of asthma based on symptoms, family history of atopy, and baseline lung function. The specialist diagnosis of asthma was used to evaluate the diagnostic value of reversibility to β2-agonist (>200 mL and 12%), PEF variation (>20%), and AHR to methacholine (PD20<7.8 µmol) or AHR to mannitol (PD15<635 mg). The study was approved by the local ethics committee (H-3-2011-121).

Bottom Line: 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%.

View Article: PubMed Central - PubMed

Affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.

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).

No MeSH data available.


Related in: MedlinePlus