If the diagnosis of asthma remains unclear in older children and adults, consider bronchoprovocation of airway hyperresponsiveness as a more sensitive test for asthma.Ī bronchoprovocation test uses methacholine (and less frequently mannitol) and standardized protocols. No good evidence exists for or against bronchodilator reversibility testing in children.īronchoprovocation. In children with suggestive spirometry results, consider bronchodilator reversibility testing to support the diagnosis of asthma.

9, 10 This also assumes a FEV 1 increase of 200mL, to avoid confounding in the setting of a very low baseline FEV 1. A 12% increase in FEV 1 is traditionally considered a positive test, and has a sensitivity of 17-65%, and a specificity of 61-81%. Perform spirometry before and after the patient inhales a short-acting beta agonist. Like spirometry, bronchodilator reversibility testing is more specific than sensitive and is more useful to rule in a diagnosis of asthma. In adults with suggestive spirometry results, perform a test of reversibility to support the diagnosis of asthma. One study of school-age children showed that an FEV 1 < 80% of predicted had a sensitivity of 52% and a specificity of 72%. 5 Pooled data used in the 2017 NICE guidelines showed that using the criterion of FEV 1<80% of predicted to diagnose asthma had a median sensitivity of 29% (range 23-47%) and a corresponding specificity of 100% (range 32-100%). In adults, an FEV 1/FVC ratio under 0.7 has a specificity of 100% in diagnosing asthma but a sensitivity of only 35%. Spirometry is more specific than sensitive. Basic spirometry, which include measurement of FEV 1 and the FEV 1/FVC ratio, is the first-line test to evaluate asthma in patients with symptoms and signs. In adults and older children with symptoms and signs of asthma, obtain spirometry.

Nocturnal asthma symptoms in adults