Concordance between ERS, GINA and NICE guidelines for the diagnosis of asthma in adults

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Introduction: Significant heterogeneity exists in the approach to diagnosing asthma across guidelines. Aim: Evaluate the concordance between the European Respiratory Society (ERS), the National Institute for Health and Care Excellence (NICE) and the Global Initiative for Asthma (GINA) guidelines for diagnosing asthma in adults. Methods: Patients with symptoms suggestive of asthma, but not on inhaled corticosteroids (ICS) underwent thorough investigation, including: spirometry, bronchodilator reversibility, FeNO, peak expiratory flow variability, bronchial challenge testing, blood eosinophils, and response to ICS treatment. Results were run through the diagnostic algorithms of NICE, GINA and ERS. Reference standard was determined by an expert panel (AsthmaEP). Concordance was established using Cohen’s kappa statistic. Results: Of 118 adults [75 female, mean (SD) age 36 (12) yr], 41 (35%) did not have asthma by any of the four approaches, and only 21 (18%) had asthma by all four (Figure). GINA and NICE displayed similar levels of agreement with the expert panel, however concordance between all guidelines was only moderate (Figure). Conclusion: Current asthma guidelines give different diagnostic outcomes in a significant number of cases. To avoid conflicting diagnoses, guidelines need to be unified and tested prospectively in an appropriate population and against a robust reference standard. erj;64/suppl_68/PA1250/F1 F1 F1

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