{
  "abstract": "Introduction In 2024 both the Global Initiative for Asthma (GINA) and National Institute for Health and Care Excellence (NICE) published updated asthma diagnostic guidance for children. Both removed the need to identify airway obstruction (FEV 1:FVC < lower limit of normal), NICE also added testing for atopy via house dust mite (HDM) sensitisation or raised blood IgE and eosinophil levels into the diagnostic algorithm.Aim To review the effect of guidance updates on the sensitivity and specificity of asthma diagnosis.Methods Children with a clinical suspicion of asthma and not yet treated with inhaled corticosteroids (ICS) were recruited to the RADicA study. An expert panel classified the children as ‘asthma’ or ‘not asthma’ based on clinical history & examination, spirometry, bronchodilator reversibility, fractional exhaled nitric oxide, peak expiratory flow variability, bronchial challenge testing, allergy testing, blood eosinophil count and treatment response to 8-weeks of ICS. Children were then reclassified using GINA and NICE guidance before and after updates. Children with a missing result were classed as having a negative test. For NICE 2024 either a positive HDM sensitisation or raised IgE and eosinophil was taken as a positive result. The sensitivity and specificity of the varying guidance was calculated using expert panel diagnosis as the reference standard.Results 134 children aged 5–16 years (mean age 9 years [SD 3 years], male n=66 [49%]) were classified as asthma (n=101) or not asthma (n=33) by expert panel. Table 1 shows how these children were classified by the various diagnostic guidance. Both GINA and NICE demonstrated an increase in children diagnosed as asthma using updated guidance. Analysis of NICE diagnostic pathways using HDM alone resulted in 88 children diagnosed as asthma (sensitivity 75% [CI 66–83], specificity 62% [CI 45–80]) compared to IgE and eosinophils diagnosing 75 children (sensitivity 69% [CI 59–78], specificity 85% [CI 68–96])Abstract S46 Table 1Performance of paediatric asthma diagnostic guidance before and after published changes Asthma N (%) Sensitivity % (CI) Specificity % (CI) PPV % (CI) NPV % (CI) GINA 2023 22 (16%) 22 (14–31) 100 (89–100) 100 (85–100) 29 (27–32) GINA 2024 66 (48%) 61 (51–71) 88 (72–97) 94 (86–98) 43 (36–50) NICE 2017 25 (19%) 25 (17–34) 100 (89–100) 100 (86–100) 30 (28–33) NICE 2024 96 (70%) 83 (74–90) 64 (45–80) 88 (82–92) 55 (43–85) Abbreviations: PPV, positive predictive value; NPV, negative predictive value; CI, confidence intervalConclusion Both updated guidelines result in a significantly higher number of positive asthma diagnosis being made in children. After removing the need for obstruction, GINA maintains a moderate specificity. However, the specificity of NICE pathways has been reduced by the use of HDM or raised blood IgE and eosinophils.",
  "authors": [
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "L Healy"
    },
    {
      "affiliations": [
        "University of Hull, Hull, UK"
      ],
      "name": "AJ Simpson"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "R Wang"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "M Bennett"
    },
    {
      "affiliations": [
        "Manchester University NHS Foundation Trust, Manchester, UK"
      ],
      "name": "L Whipday"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "L Willmore"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "SJ Fowler"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "A Simpson"
    },
    {
      "affiliations": [
        "The University of Manchester, Manchester, UK"
      ],
      "name": "CS Murray"
    }
  ],
  "title": "S46 Evaluating recent changes to paediatric asthma diagnostic guidance from GINA and NICE",
  "uid": "92e41ce7-caa3-5700-8d10-b673d77840c1"
}