Excerpt

This guideline offers best practice advice on the care of people with suspected asthma presenting with respiratory symptoms, and monitoring asthma control in people with a confirmed diagnosis of asthma. Chapters 6 to 10 review the diagnostic accuracy of the initial clinical assessment questions for the diagnosis of asthma in people with suspected asthma presenting with respiratory symptoms. Chapters 11 to 20 review the diagnostic test accuracy of objective tests for the diagnosis of asthma in people with suspected asthma presenting with respiratory symptoms. The diagnostic pathway can be found in section 4.1. Chapters 23 to 30 review the clinical and cost-effectiveness of interventions used to monitor asthma control.

Contents

• Guideline committee members
• NGC technical team members
• Acknowledgements
• 1. Introduction
  • 1.1. Phased implementation
• 2. Development of the guideline
  • 2.1. What is a NICE clinical guideline?
  • 2.2. Remit
  • 2.3. Who developed this guideline?
• 3. Methods
  • 3.1. Developing the review questions and outcomes
  • 3.2. Searching for evidence
  • 3.3. Updated searches 2017
  • 3.4. Evidence of effectiveness
  • 3.5. Evidence of cost-effectiveness
  • 3.6. Developing recommendations
• 4. Guideline summary
  • 4.1. Diagnostic algorithms
  • 4.2. Full list of recommendations
  • 4.3. Key research recommendations
• 5. Diagnosing asthma
  • 5.1. Initial clinical assessment
  • 5.2. Objective tests
• 6. Diagnosis: Signs and symptoms
  • 6.1. Introduction
  • 6.2. Review question: In people under investigation for asthma, what is the diagnostic accuracy of each of the following signs and symptoms?
  • 6.3. Clinical evidence
  • 6.4. Economic evidence
  • 6.5. Evidence statements
  • 6.6. Recommendations and link to evidence
• 7. Diagnosis: History of atopic disorders
  • 7.1. Introduction
  • 7.2. Review question: In people under investigation for asthma, what is the diagnostic accuracy of taking a personal/family history of atopic disorders?
  • 7.3. Clinical evidence
  • 7.4. Economic evidence
  • 7.5. Evidence statements
  • 7.6. Recommendations and link to evidence
• 8. Diagnosis: Symptoms after exercise
  • 8.1. Introduction
  • 8.2. Review question: In people under investigation for asthma, what is the diagnostic accuracy of a clinical history of symptoms in response to exercise?
  • 8.3. Clinical evidence
  • 8.4. Economic evidence
  • 8.5. Evidence statements
  • 8.6. Recommendations and link to evidence
• 9. Diagnosis: Symptoms after using medication
  • 9.1. Introduction
  • 9.2. Review question: In people under investigation for asthma, what is the diagnostic accuracy of a clinical history of symptoms after taking the following drugs
  • 9.3. Clinical evidence
  • 9.4. Economic evidence
  • 9.5. Evidence statements
  • 9.6. Recommendations and link to evidence
• 10. Diagnosis: Occupational asthma
  • 10.1. Introduction
  • 10.2. Review question: In adults under investigation for occupational asthma, what is the diagnostic accuracy for case identification, of asking whether their symptoms are better away from work?
  • 10.3. Clinical evidence
  • 10.4. Economic evidence
  • 10.5. Evidence statements
  • 10.6. Recommendations and link to evidence
• 11. Diagnosis: Spirometry
  • 11.1. Introduction
  • 11.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of spirometry/flow volume loop measures?
  • 11.3. Clinical evidence
  • 11.4. Economic evidence
  • 11.5. Evidence statements
  • 11.6. Recommendations and link to evidence
• 12. Diagnosis: Bronchodilator reversibility
  • 12.1. Introduction
  • 12.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of bronchodilator response (using PEF or FEV1)?
  • 12.3. Clinical evidence
  • 12.4. Economic evidence
  • 12.5. Evidence statements
  • 12.6. Recommendations and link to evidence
• 13. Diagnosis: Peak expiratory flow variability
  • 13.1. Introduction
  • 13.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of peak expiratory flow (PEF) variability?
  • 13.3. Clinical evidence
  • 13.4. Economic evidence
  • 13.5. Evidence statements
  • 13.6. Recommendations and link to evidence
• 14. Diagnosis: Skin prick tests
  • 14.1. Introduction
  • 14.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of skin prick tests?
  • 14.3. Clinical evidence
  • 14.4. Economic evidence
  • 14.5. Evidence statements
  • 14.6. Recommendations and link to evidence
• 15. Diagnosis: Serum IgE measures
  • 15.1. Introduction
  • 15.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of total and specific serum IgE measures?
  • 15.3. Clinical evidence
  • 15.4. Economic evidence
  • 15.5. Evidence statements
  • 15.6. Recommendations and link to evidence
• 16. Diagnosis: Fractional exhaled nitric oxide (FeNO)
  • 16.1. Introduction
  • 16.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of fractional exhaled nitric oxide (FeNO) measures?
  • 16.3. Clinical evidence
  • 16.4. Economic evidence
  • 16.5. Evidence statements
  • 16.6. Recommendations and link to evidence
• 17. Diagnosis: Peripheral blood eosinophil count
  • 17.1. Introduction
  • 17.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of eosinophil blood count measures?
  • 17.3. Clinical evidence
  • 17.4. Economic evidence
  • 17.5. Evidence statements
  • 17.6. Recommendations and link to evidence
• 18. Diagnosis: Direct bronchial challenge test with histamine and methacholine
  • 18.1. Introduction
  • 18.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of airway hyper-reactivity (non-specific bronchial challenge) with histamine and methacholine?
  • 18.3. Clinical evidence
  • 18.4. Economic evidence
  • 18.5. Evidence statements
  • 18.6. Recommendations and link to evidence
• 19. Diagnosis: Indirect bronchial challenge test with mannitol
  • 19.1. Introduction
  • 19.2. Review question: In people under investigation for asthma, what is the diagnostic test accuracy and cost-effectiveness of airway hyper-reactivity (non-specific bronchial challenge) with mannitol?
  • 19.3. Clinical evidence
  • 19.4. Economic evidence
  • 19.5. Evidence statements
  • 19.6. Recommendations and link to evidence
• 20. Diagnosis: Indirect bronchial challenge test with exercise
  • 20.1. Introduction
  • 20.2. Review question: In people under investigation for asthma, what is the diagnostic accuracy of bronchoconstriction in response to an exercise challenge?
  • 20.3. Clinical evidence
  • 20.4. Economic evidence
  • 20.5. Evidence statements
  • 20.6. Recommendations and link to evidence
• 21. Diagnostic summaries
  • 21.1. Diagnostic algorithms
  • 21.2. Recommendations and link to evidence
• 22. Monitoring asthma control
• 23. Monitoring: Symptom scores and questionnaires
  • 23.1. Introduction
  • 23.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of using symptom scores / diaries or validated questionnaires measuring symptom control (eg ACT, ACQ, CACT, RCP 3 questions) and / or health related quality of life (eg AQLQ, PAQLQ) to monitor asthma?
  • 23.3. Clinical evidence
  • 23.4. Economic evidence
  • 23.5. Evidence statements
  • 23.6. Recommendations and link to evidence
• 24. Monitoring: Lung function tests
  • 24.1. Introduction
  • 24.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of using measures of pulmonary function assessing asthma control (for example, spirometry and peak expiratory flow) to monitor asthma?
  • 24.3. Clinical evidence
  • 24.4. Economic evidence
  • 24.5. Evidence statements
  • 24.6. Recommendations and link to evidence
• 25. Monitoring: Fractional exhaled nitric oxide (FeNO)
  • 25.1. Introduction
  • 25.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of using fractional exhaled nitric oxide (FeNO) measures for monitoring asthma control?
  • 25.3. Clinical evidence
  • 25.4. Economic evidence
  • 25.5. Evidence statements
  • 25.6. Recommendations and link to evidence
• 26. Monitoring: Peripheral blood eosinophil count
  • 26.1. Introduction
  • 26.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of using the peripheral blood eosinophil count for monitoring asthma control?
  • 26.3. Clinical evidence
  • 26.4. Economic evidence
  • 26.5. Evidence statements
  • 26.6. Recommendations and link to evidence
• 27. Monitoring: Challenge tests
  • 27.1. Introduction
  • 27.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of using indirect challenge tests with mannitol or direct challenge tests with histamine or methacholine for monitoring asthma control?
  • 27.3. Clinical evidence
  • 27.4. Economic evidence
  • 27.5. Evidence statements
  • 27.6. Recommendations and link to evidence
• 28. Monitoring adherence to treatment
  • 28.1. Introduction
  • 28.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of monitoring adherence to treatment?
  • 28.3. Clinical evidence
  • 28.4. Economic evidence
  • 28.5. Evidence statements
  • 28.6. Recommendations and link to evidence
• 29. Monitoring inhaler technique
  • 29.1. Introduction
  • 29.2. Review question: In people with asthma, what is the optimal frequency and method for monitoring inhaler technique?
  • 29.3. Clinical evidence
  • 29.4. Economic evidence
  • 29.5. Evidence statements
  • 29.6. Recommendations and link to evidence
• 30. Monitoring: Tele-healthcare
  • 30.1. Introduction
  • 30.2. Review question: In people with asthma, what is the clinical and cost-effectiveness of tele-healthcare to monitor asthma control?
  • 30.3. Clinical evidence
  • 30.4. Economic evidence
  • 30.5. Evidence statements
  • 30.6. Recommendations and link to evidence
• 31. Reference list
• 32. Acronyms and abbreviations
• 33. Glossary
• Appendices
  • Appendix A. Scope
  • Appendix B. Declarations of interest
  • Appendix C. Review protocols
  • Appendix D. Clinical article selection
  • Appendix E. Economic article selection
  • Appendix F. Literature search strategies
  • Appendix G. Clinical evidence tables
  • Appendix H. Economic evidence tables
  • Appendix I. GRADE tables
  • Appendix J. Forest plots
  • Appendix K. Excluded clinical studies
  • Appendix L. Excluded economic studies
  • Appendix M. Cost-effectiveness analysis: Diagnosis of asthma in adults and young people aged over 16
  • Appendix N. Research recommendations
  • Appendix O. Contributors to the guideline
  • Appendix P. References
  • Appendix Q. Feasibility report
  • Appendix R. Summary of evidence from 2017 updated searches for Asthma: diagnosis and monitoring

Final version

Commissioned by the National Institute for Health and Care Excellence

Disclaimer: Healthcare professionals are expected to take NICE clinical guidelines fully into account when exercising their clinical judgement. However, the guidance does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of each patient, in consultation with the patient and/or their guardian or carer.