Making the diagnosis of asthma

BMJ 1998; 316 doi: https://doi.org/10.1136/bmj.316.7125.150a (Published 10 January 1998) Cite this as: BMJ 1998;316:150

Measurement of airway responsiveness should be more readily available

  1. Ian D Pavord, Consultant physiciana
  1. a Glenfield Hospital, Leicester LE3 9QP
  2. b Respiratory Unit, Western General Hospital, Edinburgh EH4 2XU
  3. c University Hospital of Wales, Cardiff CF4 4XW

    Editor—I welcome Taylor's call for greater use of objective tests of variable airflow obstruction in patients with suspected asthma and particularly his cautious endorsement of measurement of airway responsiveness.1 I do not, however, agree with him that the relatively weak correlation between measures of the variability in peak expiratory flow and airway responsiveness (observed in community studies) confirms that these tests measure different pathophysiological aspects of asthma. A more likely explanation is that, in most situations, both tests identify a similar abnormality but that measurement of airway responsiveness does so much more successfully than serial monitoring of peak expiratory flow.

    This view is supported by several studies showing that, to achieve the same level of specificity, the sensitivity of various measures of the variability in peak expiratory flow in detecting symptomatic asthma in a community population is two to four times less than that of measurement of airway responsiveness.2 3 Furthermore, if attempts are made to increase …

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