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Last reviewed: 21 Apr 2025
Last updated: 24 Oct 2024

Summary

Your Organizational Guidance

ebpracticenet urges you to prioritize the following organizational guidance:

Astma bij volwassenen: diagnose en monitoring in de eerste lijnPublished by: Werkgroep Ontwikkeling Richtlijnen Eerste Lijn (Worel)Last published: 2020Asthme chez l’adulte : diagnostic et surveillance en soins de santé primairesPublished by: Groupe de Travail Développement de recommmandations de première ligneLast published: 2020

Definition

History and exam

Key diagnostic factors

  • recent upper respiratory tract infection
  • dyspnea
  • cough
  • expiratory wheezes
  • nasal polyposis
Full details

Risk factors

  • family history
  • allergens/irritants
  • atopic disease history
  • cigarette smoking
  • vaping
  • respiratory viral infection early in life
  • nasal polyposis
  • low socioeconomic status
  • obesity
  • gastroesophageal reflux
  • obstructive sleep apnea
Full details

Diagnostic tests

1st tests to order

  • FEV₁/FVC ratio
  • peak expiratory flow (PEF)
Full details

Tests to consider

  • chest x-ray
  • CBC
  • fractional exhaled nitric oxide (FeNO)
  • bronchial challenge test
  • immunoassay for allergen-specific IgE
  • skin prick allergy testing
  • high-resolution CT (HRCT) chest
  • CT sinus
Full details

Emerging tests

  • sputum eosinophil count
Full details

Treatment algorithm

ACUTE

initial treatment step 1: asthma symptoms 1-2 days per week or less and no risk factors for exacerbations

initial treatment step 2: asthma symptoms less than 3-5 days per week and normal (or mildly reduced) lung function

initial treatment step 3: asthma symptoms most days (e.g., 4-5 days per week or more), or waking due to asthma once a week or more, low lung function, and risk factors for exacerbations

initial treatment step 4: daily asthma symptoms, waking at night once a week or more, and low lung function

ONGOING

ongoing treatment step 1: patients using short-acting beta agonist (SABA) alone or with newly diagnosed asthma, with normal (or mildly reduced) lung function

ongoing treatment step 2: asthma not controlled on step 1 treatment

ongoing treatment step 3: asthma not controlled on steps 1-2 treatment (track 1) or step 2 treatment (track 2), with risk factors for exacerbations

ongoing treatment step 4: asthma not controlled on step 3 treatment

ongoing treatment step 5: asthma not controlled on step 4 treatment and patient reviewed by specialist

Contributors

Authors

Lauren E. Eggert, MD

Clinical Assistant Professor

Division of Pulmonary, Allergy, and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

LEE has participated on advisory boards for Regeneron and AstraZeneca.

Sourav Majumdar, MD

Clinical Assistant Professor (Affiliated)

Division of Pulmonary and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

SM declares that he has no competing interests.

Acknowledgements

Dr Lauren E. Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.

Disclosures

II, KCS, FT, and CW declare that they have no competing interests.

Peer reviewers

Javed Sheikh, MD

Clinical Director

Division of Allergy and Inflammation

Beth Israel Deaconess Medical Center/Harvard Medical School

Boston

MA

Disclosures

JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.

Sheree M.S. Smith, PhD

Research Manager

Imperial College Healthcare Trust

NHLI Airways Division

Imperial College London (Honorary) Respiratory Research

Chest & Allergy

St Mary's Hospital

London

UK

Disclosures

SMSS declares that she has no competing interests.

Neil Thomson, MBChB, MD, FRCP

Professor of Respiratory Medicine

Respiratory Medicine Section

Division of Immunology, Infection & Inflammation

University of Glasgow

Glasgow

UK

Disclosures

NT declares that he has no competing interests.

References

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

Key articles

National Institutes of Health; National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program. Expert panel report 3: Guidelines for the diagnosis and management of asthma. August 2007 [internet publication].Full text

Global Initiative for Asthma. 2024 global strategy for asthma management and prevention. May 2024 [internet publication].Full text

Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC); Cloutier MM, Baptist AP, Blake KV, et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and Prevention Program Coordinating Committee Expert Panel Working Group. J Allergy Clin Immunol. 2020 Dec;146(6):1217-70.Full text  Abstract

National Institute for Health and Care Excellence. Asthma: diagnosis, monitoring and chronic asthma management. March 2021 [internet publication].Full text

British Thoracic Society; Scottish Intercollegiate Guidelines Network. British guideline on the management of asthma: a national clinical guideline. July 2019 [internet publication].Full text

Reference articles

A full list of sources referenced in this topic is available here.

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