Asthma diagnosis: into the fourth dimension.

Publisher: British Medical Assn Country of Publication: England NLM ID: 0417353 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-3296 (Electronic) Linking ISSN: 00406376 NLM ISO Abbreviation: Thorax Subsets: MEDLINE

Original Publication: London : British Medical Assn.

Asthma/*diagnosis ; Diagnostic Imaging/*methods ; Image Processing, Computer-Assisted/*methods; Humans

Asthma is the most common chronic respiratory disease in the UK; however, the misdiagnosis rate is substantial. The lack of consistency in national guidelines and the paucity of data on the performance of diagnostic algorithms compound the challenges in asthma diagnosis. Asthma is a highly rhythmic disease, characterised by diurnal variability in clinical symptoms and pathogenesis. Asthma also varies day to day, seasonally and from year to year. As much as it is a hallmark for asthma, this variability also poses significant challenges to asthma diagnosis. Almost all established asthma diagnostic tools demonstrate diurnal variation, yet few are performed with standardised timing of measurements. The dichotomous interpretation of diagnostic outcomes using fixed cut-off values may further limit the accuracy of the tests, particularly when diurnal variability straddles cut-off values within a day, and careful interpretation beyond the 'positive' and 'negative' outcome is needed. The day-to-day and more long-term variations are less predictable and it is unclear whether performing asthma diagnostic tests during asymptomatic periods may influence diagnostic sensitivities. With the evolution of asthma diagnostic tools, home monitoring and digital apps, novel strategies are needed to bridge these gaps in knowledge, and circadian variability should be considered during the standardisation process. This review summarises the biological mechanisms of circadian rhythms in asthma and highlights novel data on the significance of time (the fourth dimension) in asthma diagnosis.
Competing Interests: Competing interests: None declared.
(© Author(s) (or their employer(s)) 2021. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)

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MR/V029460/1 United Kingdom MRC_ Medical Research Council

Keywords: asthma; asthma guidelines

Date Created: 20210128 Date Completed: 20210713 Latest Revision: 20230301

20240829

PMC8223645

10.1136/thoraxjnl-2020-216421

33504564