European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults.

Although asthma is very common affecting 5-10% of the population, the diagnosis of asthma in adults remains a challenge in the real world that results in both over- and under-diagnosis. A task force (TF) was set up by the European Respiratory Society to systematically review the literature on the diagnostic accuracy of tests used to diagnose asthma in adult patients and provide recommendation for clinical practice.The TF defined eight PICO (Population, Index, Comparator, and Outcome) questions that were assessed using the GRADE (Grading of Recommendations, Assessment, Development and Evaluation) approach, The TF utilised the outcomes to develop an evidenced-based diagnostic algorithm, with recommendations for a pragmatic guideline for everyday practice that was directed by real-life patient experiences.The TF support the initial use of spirometry followed, and if airway obstruction is present, by bronchodilator reversibility testing. If initial spirometry fails to show obstruction, further tests should be performed in the following order: FeNO, PEF variability or in secondary care, bronchial challenge. We present the thresholds for each test that are compatible with a diagnosis of asthma in the presence of current symptoms.The TF reinforce the priority to undertake spirometry and recognise the value of measuring blood eosinophils and serum IgE to phenotype the patient. Measuring gas trapping by body plethysmography in patients with preserved FEV

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Conflict of interest: Dr. LOUIS reports grants and personal fees from GSK, grants and personal fees from AZ, grants and personal fees from Chiesi, grants and personal fees from Novartis, personal fees from Sanofi, outside the submitted work; . Conflict of interest: Dr. Satia reports grants and personal fees from GSK, personal fees from AstraZeneca, grants and personal fees from Merck, grants from ERS Respire 3 Marie Curie Fellowship, grants from E.J. Moran Campbell Early Career Award, outside the submitted work; . Conflict of interest: Dr. OJANGUREN reports grants and personal fees from ASTRAZENECA, personal fees and non-financial support from BOEHRINGUER-INGELHEIM, personal fees and non-financial support from CHIESI, grants, personal fees and non-financial support from NOVARTIS, personal fees from MSD, personal fees from PURETECH, grants and personal fees from SANOFI, personal fees from BIAL, personal fees from TEVA, grants and personal fees from GSK, outside the submitted work. Conflict of interest: Dr. SCHLEICH reports grants and personal fees from GSK, grants and personal fees from AstraZeneca, personal fees from Chiesi, outside the submitted work. Conflict of interest: Dr. Bonini has nothing to disclose. Conflict of interest: Ms Tonia reports acting as ERS Methodologist . Conflict of interest: Dr. Rigau reports and declares he worked as ERS methodologist until February 2020. Conflict of interest: Dr. ten Brinke reports institutional fees from Research Advisory Boards: GSK, Sanofi, TEVA, AstraZeneca, Boehringer Ingelheim , institutional fees from Lectures AstraZeneca, GSK ,TEVA, SanofiGenzyme, grants from AstraZeneca, GSK ,TEVA, outside the submitted work. Conflict of interest: Dr. Buhl reports personal fees from AstraZeneca, Berlin-Chemie, Boehringer Ingelheim, Chiesi, Cipla, GlaxoSmithKline, Novartis, Sanofi, Roche and Teva, and grants to Mainz University Hospital from Boehringer Ingelheim, GlaxoSmithKline, Novartis and Roche, all outside the submitted work. Conflict of interest: Dr. Loukides has nothing to disclose. Conflict of interest: Dr. Kocks reports grants, personal fees and non-financial support from AstraZeneca, grants, personal fees and non-financial support from Boehringer Ingelheim, grants and personal fees from Chiesi Pharmaceuticals, grants and personal fees from GSK, grants and personal fees from Novartis, personal fees from MSD, grants and personal fees from TEVA, personal fees from COVIS, outside the submitted work; and Janwillem Kocks holds 72.5% of shares in the General Practitioners Research Institute. Conflict of interest: Dr. Boulet reports grants from Amgen, AstraZeneca, GlaxoSmithKline, Merck, Novartis, Sanofi-Regeneron, grants from AstraZeneca, GlaxoSmithKline. Merck, personal fees from Astra Zeneca, Novartis, GlaxoSmithKline, Merck, Sanofi-Regeneron, personal fees from AstraZeneca, Covis, GlaxoSmithKline, Novartis, Merck, Sanofi, grants and non-financial support from AstraZeneca, Covis, GlaxoSmithKline, Merck, Novartis, non-financial support from Chair of Global Initiative for Asthma (GINA) Board of Directors, President of the Global Asthma Organisation (Interasma) Conflict of interest: Dr. Bourdin reports grants, personal fees, non-financial support and other from GSK, grants, personal fees, non-financial support and other from Astra Zeneca, grants, personal fees, non-financial support and other from Boeringher Ingelheim, personal fees, non-financial support and other from Novartis, personal fees, non-financial support and other from Chiesi Farma, non-financial support and other from Teva, personal fees, non-financial support and other from Sanofi Regeneron, grants, personal fees, non-financial support and other from Actelion / Jansen, other from United Therapeutics, other from Pulsar, personal fees, non-financial support and other from Roche, from null, outside the submitted work. Conflict of interest: Courtney Coleman is an employee of European Lung Foundation. Conflict of interest: Dr. Needham has nothing to disclose. Conflict of interest: Dr. Thomas reports personal fees from GSK, personal fees from Boehringer Ingelheim , personal fees from Chiesi, outside the submitted work; . Conflict of interest: Dr. Idzko has nothing to disclose. Conflict of interest: Dr. Papi reports grants, personal fees, non-financial support and other from GlaxoSmithKline, grants, personal fees and non-financial support from AstraZeneca, grants, personal fees, non-financial support and other from Boehringer Ingelheim, grants, personal fees, non-financial support and other from Chiesi Farmaceutici, grants, personal fees, non-financial support and other from TEVA, personal fees, non-financial support and other from Mundipharma, personal fees, non-financial support and other from Zambon, personal fees, non-financial support and other from Novartis, grants, personal fees and non-financial support from Menarini, personal fees, non-financial support and other from Sanofi/Regeneron, personal fees from Roche, grants from Fondazione Maugeri, grants from Fondazione Chiesi, personal fees from Edmondpharma, outside the submitted work. Conflict of interest: Dr. Porsbjerg reports grants and personal fees from Astra Zeneca, grants and personal fees from GSK, grants and personal fees from Novartis, grants and personal fees from TEVA, grants and personal fees from Sanofi, grants and personal fees from Chiesi, grants from Pharmaxis, outside the submitted work; . Conflict of interest: Dr. Schuermans reports non-financial support from Free University of Brussels, outside the submitted work; . Conflict of interest: Dr. B. Soriano Conflict of interest: Dr. Usmani reports grants and personal fees from astra zeneca, grants and personal fees from boehringer ingelheim, grants and personal fees from chiesi, grants and personal fees from glaxosmithkline, personal fees from napp, personal fees from mundipharma, personal fees from sandoz, personal fees from takeda, grants from edmond pharma, personal fees from cipla, personal fees from covis, personal fees from novartis, personal fees from mereo biopharma, personal fees from orion, personal fees from menarini, personal fees from ucb, personal fees from trudell medical, personal fees from deva, personal fees from kamada, personal fees from covis, outside the submitted work.