NICE Guidelines for the Diagnosis of Asthma in Children

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Introduction: NICE guidelines propose four stages where asthma can be diagnosed: 1) fractional exhaled nitric oxide (FeNO) ≥ 35ppb, 2) bronchodilator reversibility (BDR) ≥ 12% and/or ≥ 10% of pred FEV1, 3) peak expiratory flow variability (PEFv) ≥ 20%, and 4a) sensitisation to house dust mite (HDM) and/or 4b) raised IGE with eosinophils > 0.5 x 109 per litre. Aim: Assess the sensitivity and specificity at each stage of the NICE diagnostic algorithm in RADicA, a prospective study of diagnostic methods for untreated people referred from primary care with symptoms of asthma. Methods: Reference standard was determined by a panel of asthma specialists using clinical history, physical examination, spirometry, BDR, PEFv, bronchial challenge, allergy testing, blood eosinophils, and response to 8 weeks ICS treatment. 135 children had a definitive diagnostic outcome (50% female; mean (SD) age 10 (3) y, 101 (75%) had asthma). Results: Performance at each stage of the NICE algorithm is given in the table. 20% of participants were incorrectly diagnosed compared to the specialist panel, 11% with asthma were missed. 9% received a false positive diagnosis, mostly with sensitisation to HDM as the only positive test. Using the IGE + eosin instead of HDM sensitisation in the final stage improves the specificity of the algorithm. Conclusion: The NICE algorithm provides reasonable sensitivity; however, caution should be made making a diagnosis based on HDM alone. erj;66/suppl_69/PA3779/F1 F1 F1

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