Asthma : diagnostic tests ( NICE summary )

The National Institute for Health and Care Excellence (NICE) guidelines emphasize a structured and comprehensive approach to diagnosing asthma, starting with a detailed clinical history and physical examination, followed by objective testing. The initial step involves taking a structured clinical history from individuals with suspected asthma, focusing on symptoms such as wheeze, cough, and breathlessness, including their daily or seasonal variation, any exacerbating triggers, and a personal or family history of atopic disorders. However, NICE strongly advises against using symptoms or a history of atopic disorders alone as a basis for an asthma diagnosis.

In addition to the clinical history, a physical examination should be performed to identify signs such as expiratory polyphonic wheeze and to rule out other causes of respiratory symptoms. It is important to recognize that normal examination results do not exclude the diagnosis of asthma, as the condition's presentation can be variable and sometimes subtle.

Regarding testing for asthma, NICE guidelines specify that certain tests should not be offered as diagnostic tools for asthma. These include skin prick tests to aeroallergens, serum total and specific IgE measurements, peripheral blood eosinophil count, and exercise challenges (for adults aged 17 and over). Instead, these tests may be utilized...