Skip to main content
SpringerLink
Log in

Screening, Diagnostic and Outcome Tools for Asthma

  • Review Article
  • Interventions & Outcomes
  • Published:
Disease Management and Health Outcomes

Summary

Asthma is a chronic inflammatory disorder of the airways, affecting about 10% of children and 5 to 7% of the adult population. Improved asthma control will not only benefit the patient but will also result in reduced financial expenditure in asthma healthcare.

This article summarises the tools that are available for assessing asthma and attempts to quantify the usefulness of each tool in assessing asthma in different clinical contexts, whether it be screening for asthmatics within a population, diagnosing asthma in an individual, influencing management or judging outcome. The overall role of the symptoms of asthma, lung function variables, bronchial hyperresponsiveness, atopy and biological markers of inflammation, as well as their application in various settings is summarised in tabulated form. Flow charts are presented proposing sequential testing in the screening and diagnostic procedures.

Intervention and treatment strategies for the individual are subsequently considered. Prevention should be the start of the intervention, educating the patient to enhance disease knowledge and avoidance of environmental triggers ideally resulting in a change in behaviour, to which teaching programmes may contribute.

Since the recognition that asthma is an inflammatory disorder resulting in variable and reversible airflow obstruction, inhaled corticosteroids have become the mainstay treatment, with inhaled bronchodilators to be prescribed on an as-needed basis. Recently the long-acting β2-agonist bronchodilators have been shown to be especially effective in treating nocturnal symptoms and together with inhaled corticosteroids achieve better control of asthma.

Considering the complex nature of the asthmatic inflammatory process, respiratory symptoms, lung function variables and biomarkers are presently used as complementary outcome measures; the frequency of assessment will depend on practical considerations.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Sheffer AL, editor. Asthma management and prevention: a practical guide for public health care professionals (based on the global strategy for asthma management and prevention NHLBI/WHO workshop report). Bethesda (MD): National Institute of Health, 1995. Publication no. 95-3659A.

    Google Scholar 

  2. Woolcock AJ, Peat JK. Definition, classification, epidemiology and risk factors for asthma. In: O’Byrne P, Thomson NC, editors. Manual of asthma management. London: WB Saunders Company Ltd, 1995: 3–27.

    Google Scholar 

  3. European Community Respiratory Health Survey. Variations in the prevalence of respiratory symptoms, self-reported asthma attacks, and use of asthma medication in the European Community Respiratory Health Survey (ECRHS). Eur Respir J 1996; 9: 687–95.

    Article  Google Scholar 

  4. Sullivan S, Elixhauser A, Buist AS, et al. National asthma education and prevention program working group report on the cost effectiveness of asthma care. Am J Respir Crit Care Med 1996; 154: S84–95.

    PubMed  CAS  Google Scholar 

  5. Barnes PJ, Jonsson B, Klim JB. The costs of asthma. Eur Respir J 1996; 9: 636–42.

    Article  PubMed  CAS  Google Scholar 

  6. Corren J. Allergic rhinitis and asthma: how important is the link? J Allergy Clin Immunol 1997; 99: S781–6.

    Article  PubMed  CAS  Google Scholar 

  7. Barnes PJ. Poorly perceived asthma. Thorax 1992; 47: 408–9.

    Article  PubMed  CAS  Google Scholar 

  8. Quanjer PhH, Tammeling GJ, Cotes JE, et al. Lung volumes and forced ventilatory flows. Report Working Party: standardization of lung function tests. European Community for Steel and Coal. Eur Respir J 1993; 6 Suppl. 16: 5–40.

    Google Scholar 

  9. Jones KP, Mullee MA, Middleton M, et al. Peak flow based asthma self-management: a randomised controlled study in general practice. Thorax 1995; 50: 851–7.

    Article  PubMed  CAS  Google Scholar 

  10. Verscheiden P, Cartier A, L’Archeveque J, et al. Compliance with and accuracy of daily self-assessment of peak expiratory flows (PEF) in asthmatic subjects over a three month period. Eur Respir J 1996; 9: 880–5.

    Article  Google Scholar 

  11. Sterk PJ, Fabbri LM, Quanjer PhH, et al. Airway responsiveness. Standardized challenge testing with pharmacological, physical and sensitizing stimuli in adults. Report Working Party: standardization of lung function tests. European Community for Steel and Coal. Eur Respir J 1993; 6 Suppl. 16: 53–83.

    Google Scholar 

  12. Jansen DF, Timens W, Kraan J, et al. (A)symptomatic bronchial hyper-responsiveness and asthma. Respir Med 1997; 91: 121–34.

    Article  PubMed  CAS  Google Scholar 

  13. Josephs LK, Gregg I, Holgate ST. Does non-specific bronchial responsiveness indicate the severity of asthma? Eur Respir J 1990; 3: 220–7.

    PubMed  CAS  Google Scholar 

  14. Colloff MJ, Ayres J, Carswell F, et al. The control of allergens of dust mites and domestic pets: a position paper. Clin Exp Allergy 1992; 22 Suppl. 2: 1–28.

    Article  Google Scholar 

  15. Wever AMJ, Wever-Hess J. Testing for inhalant allergy in asthma. Clin Exp Allergy 1993; 23: 976–81.

    Article  PubMed  CAS  Google Scholar 

  16. Jones PW. Quality of life measurement in asthma. Eur Respir J 1995; 8: 885–7.

    PubMed  CAS  Google Scholar 

  17. Wilson SR, Scamagas P, German DF, et al. A controlled trial of two forms of self-management education for adults with asthma. Am J Med 1993; 94: 564–76.

    Article  PubMed  CAS  Google Scholar 

  18. Ignacio-Garcia JM, Gonzalez-Santos P. Asthma self-management education program by home monitoring of peak expiratory flow. Am J Respir Crit Care Med 1995; 151: 353–9.

    PubMed  CAS  Google Scholar 

  19. Ronchetti R, Indinnimeo L, Bonci E, et al, and the Italian Study Group on Self-Management Programmes. Asthma self-management programmes in a population of Italian children: a multicentric study. Eur Respir J 1997; 10: 1248–53.

    Article  PubMed  CAS  Google Scholar 

  20. Bernard-Bonnin A–C, Stachenko S, Bonin D, et al. Self-management teaching programs and morbidity of pediatric asthma: a meta-analysis. J Allergy Clin Immunol 1995; 95: 34–41.

    Article  PubMed  CAS  Google Scholar 

  21. Madge P, McColl J, Paton J. Impact of a nurse-led home management training programme in children admitted to hospital with acute asthma: a randomised controlled trial. Thorax 1997; 52: 223–8.

    Article  PubMed  CAS  Google Scholar 

  22. Sarpong SB, Hamilton RG, Eggleston PA, et al. Socioeconomic status and race as risk factors for cockroach allergen exposure and sensitization in children with asthma. J Allergy Clin Immunol 1996; 97: 1393–401.

    Article  PubMed  CAS  Google Scholar 

  23. Murray AB, Ferguson AC. Dust-free bedrooms in the treatment of asthmatic children with house dust or house dust mite allergy: a controlled trial. Pediatrics 1983; 71: 418–22.

    PubMed  CAS  Google Scholar 

  24. Murray AB, Morrison BJ. The decrease in severity of asthma in children of parents who smoke since the parents have been exposing them to less cigarette smoke. J Allergy Clin Immunol 1993; 91: 102–10.

    Article  PubMed  CAS  Google Scholar 

  25. Hovell MF, Meltzer SB, Zakarian JM, et al. Reduction of environmental tobacco smoke exposure among asthmatic children: a controlled trial [published erratum appears in Chest 1995; 107: 1480]. Chest 1994; 106: 440–6.

    Article  PubMed  CAS  Google Scholar 

  26. Frederick JM, Warner JO, Jessop WJ, et al. Effect of a bed covering system in children with asthma and house dust mite hypersensitivity. Eur Respir J 1997; 10: 361–6.

    Article  PubMed  CAS  Google Scholar 

  27. Williamson IJ, Martin CJ, McGill G, et al. Damp housing and asthma: a case-control study. Thorax 1997; 52: 229–34.

    Article  PubMed  CAS  Google Scholar 

  28. Haahtela T, Järvinen M, Kava T, et al. Comparison of a β2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med 1991; 325: 388–92.

    Article  PubMed  CAS  Google Scholar 

  29. Laitinen LA, Laitinen A, Haahtela T. A comparative study of the effects of an inhaled corticosteroid, budesonide, and a β2-agonist, terbutaline, on airway inflammation in newly diagnosed asthma: a randomized, double-blind, parallel-group controlled trial. J Allergy Clin Immunol 1992; 90: 32–42.

    Article  PubMed  CAS  Google Scholar 

  30. Juniper EF, Kline PA, Vanzieleghem MA, et al. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonste-roid-dependent asthmatics. Am Rev Respir Dis 1990; 142: 832–6.

    PubMed  CAS  Google Scholar 

  31. Van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, et al., and the Dutch Chronic Non-Specific Lung Disease Study Group. Effects of 22 months of treatment with inhaled corticosteroids and/or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. Am Rev Respir Dis 1992; 146: 547–54.

    PubMed  Google Scholar 

  32. Kerstjens HAM, Brand PLP, Hughes MD, etal., and the Dutch Chronic Non-Specific Lung Disease Study Group. A comparison of bronchodilator therapy with or without inhaled corticosteroid therapy for obstructive airways disease. N Engl J Med 1992; 327: 1413–9.

    Article  PubMed  CAS  Google Scholar 

  33. Haahtela T, Järvinen M, Kava T, et al. Effects of reducing or discontinuing inhaled budesonide in patients with mild asthma. N Engl J Med 1994; 331: 700–5.

    Article  PubMed  CAS  Google Scholar 

  34. Agertoft L, Pedersen S. Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. Respir Med 1994; 88: 373–81.

    Article  PubMed  CAS  Google Scholar 

  35. Selroos O, Pietinalho A, Löfroos A–B, et al. Effect of early vs late intervention with inhaled corticosteroids in asthma. Chest 1995; 108: 1228–34.

    Article  PubMed  CAS  Google Scholar 

  36. Overbeek SE, Kerstjens HAM, Bogaard JM, et al., and the Dutch Chronic Non-Specific Lung Disease Study Group. Is delayed introduction of inhaled corticosteroids harmful in patients with obstructive airways disease (asthma and COPD)? Chest 1996; 110: 35–41.

    Article  PubMed  CAS  Google Scholar 

  37. Juniper EF, Kline PA, Vanzieleghem MA, et al. Reduction of budesonide after a year of increased use: a randomized controlled trial to evaluate whether improvements in airway responsiveness and clinical asthma are maintained. J Allergy Clin Immunol 1991; 87: 483–9.

    Article  PubMed  CAS  Google Scholar 

  38. Barnes NC, Hallett C, Harris TAJ. Clinical experience with fluticasone propionate in asthma: a meta-analysis of efficacy and systemic activity compared with budesonide and beclomethasone dipropionate at half the microgram dose or less. Respir Med 1998; 92: 95–104.

    Article  PubMed  CAS  Google Scholar 

  39. Britton MG, Earnshaw JS, Palmer JB. A twelve month comparison of salmeterol with salbutamol in asthmatic patients. European Study Group [published corrigendum appears in Eur Respir J 1993; 6: 150]. Eur Respir J 1992; 5: 1062–7.

    PubMed  CAS  Google Scholar 

  40. Pauwels RA, Löfdahl C–G, Postma DS, et al., forthe Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. Effect of inhaled formoterol and budesonide on exacerbations of asthma. N Engl J Med 1997; 337: 1405–11.

    Article  PubMed  CAS  Google Scholar 

  41. Holgate ST, Bradding P, Sampson AP. Leukotriene antagonists and synthesis inhibitors: new directions in asthma therapy. J Allergy Clin Immunol 1996; 98: 1–13.

    Article  PubMed  CAS  Google Scholar 

  42. Haley KJ, Drazen JM. Inflammation and airway function in asthma. What you see is not necessarily what you get [editorial]. Am J Respir Crit Care Med 1998; 157: 1–3.

    PubMed  CAS  Google Scholar 

  43. Holgate S. Is asthma an inflammatory disease? Eur Respir Rev 1994, 4: 24; 388–90.

    Google Scholar 

  44. Chapman ID, Foster A, Morley J. The relationship between inflammation and hyperreactivity of the airways in asthma. Clin Exp Allergy 1993; 23: 168–71.

    Article  PubMed  CAS  Google Scholar 

  45. Wever AMJ, Wever-Hess J, Dahl R. Use of assessment of inflammation in management of drug therapy in asthma. Clin Immunother 1995; 4: 462–70.

    Google Scholar 

  46. Wever AMJ, Wever-Hess J, Hermans J. The use of serum eosinophil cationic protein (ECP) in the management of steroid therapy in chronic asthma. Clin Exp Allergy 1997; 27: 519–29.

    Article  PubMed  CAS  Google Scholar 

  47. Greening AP, Ind PW, Northfield M, Shaw G. Added salmeterol versus higher-dose corticosteroid in asthma patients with symptoms on existing inhaled corticosteroid. Lancet 1994; 344: 219–24.

    Article  PubMed  CAS  Google Scholar 

  48. Woolcock A, Lundbeck B, Ringdal N, et al. Comparison of addition of salmeterol to inhaled steroids with doubling of the dose of inhaled steroids. Am J Respir Crit Care Med 1996; 153: 1481–8.

    PubMed  CAS  Google Scholar 

  49. Pedersen B, Dahl R, Karlström R, et al. Eosinophil and neutrophil activity in asthma in a one-year trial with inhaled budesonide. Am J Respir Crit Care Med 1996; 153: 1519–29.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Respiratory Medicine, Red Cross Hospital, Sportlaan 600, 2566 MJ, The Hague, The Netherlands

    Anthony M. J. Wever (Consultant Chest Physician, chairman of the Medical Ethical Committee) &  Jopie Wever-Hess (Senior Researcher)

  2. Department of Respiratory Medicine, St Peter’s Hospital, Chertsey, England

    Mark G. Button (Consultant Physician, Medical Director of the Trust)

Authors
  1. Anthony M. J. Wever
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jopie Wever-Hess
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Mark G. Button
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wever, A.M.J., Wever-Hess, J. & Button, M.G. Screening, Diagnostic and Outcome Tools for Asthma. Dis-Manage-Health-Outcomes 3, 229–238 (1998). https://doi.org/10.2165/00115677-199803050-00003

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00115677-199803050-00003

Keywords

Search

Navigation