675 lines
160 KiB
Text
675 lines
160 KiB
Text
<!DOCTYPE html>
|
|
<html xmlns="http://www.w3.org/1999/xhtml" xml:lang="en" class="no-js no-jr">
|
|
<head>
|
|
<!-- For pinger, set start time and add meta elements. -->
|
|
<script type="text/javascript">var ncbi_startTime = new Date();</script>
|
|
|
|
<!-- Logger begin -->
|
|
<meta name="ncbi_db" content="books">
|
|
<meta name="ncbi_pdid" content="book-toc">
|
|
<meta name="ncbi_acc" content="NBK612145">
|
|
<meta name="ncbi_domain" content="niceng245er1">
|
|
<meta name="ncbi_report" content="reader">
|
|
<meta name="ncbi_type" content="fulltext">
|
|
<meta name="ncbi_objectid" content="">
|
|
<meta name="ncbi_pcid" content="/NBK612145/?report=reader">
|
|
<meta name="ncbi_pagename" content="Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma - NCBI Bookshelf">
|
|
<meta name="ncbi_bookparttype" content="toc">
|
|
<meta name="ncbi_app" content="bookshelf">
|
|
<!-- Logger end -->
|
|
|
|
<!--component id="Page" label="meta"/-->
|
|
<script type="text/javascript" src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.boots.min.js"> </script><title>Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma - NCBI Bookshelf</title>
|
|
<meta charset="utf-8">
|
|
<meta name="apple-mobile-web-app-capable" content="no">
|
|
<meta name="viewport" content="initial-scale=1,minimum-scale=1,maximum-scale=1,user-scalable=no">
|
|
<meta name="jr-col-layout" content="1">
|
|
<meta name="robots" content="INDEX,FOLLOW,NOARCHIVE,NOIMAGEINDEX">
|
|
<meta name="citation_title" content="Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma">
|
|
<meta name="citation_publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="citation_date" content="2024/11">
|
|
<meta name="citation_pmid" content="39965062">
|
|
<meta name="citation_fulltext_html_url" content="https://www.ncbi.nlm.nih.gov/books/NBK612145/">
|
|
<meta name="citation_keywords" content="Asthma">
|
|
<meta name="citation_keywords" content="Spirometry">
|
|
<meta name="citation_keywords" content="Diagnosis">
|
|
<meta name="citation_keywords" content="Diagnostic Techniques, Respiratory System">
|
|
<meta name="citation_keywords" content="Respiratory Function Tests">
|
|
<meta name="citation_keywords" content="Treatment Outcome">
|
|
<meta name="citation_keywords" content="Cost-Benefit Analysis">
|
|
<meta name="citation_keywords" content="Child, Preschool">
|
|
<meta name="citation_keywords" content="Child">
|
|
<meta name="citation_keywords" content="Adolescent">
|
|
<meta name="citation_keywords" content="Young Adult">
|
|
<meta name="citation_keywords" content="Adult">
|
|
<meta name="citation_keywords" content="Middle Aged">
|
|
<meta name="citation_keywords" content="Aged">
|
|
<meta name="citation_keywords" content="Aged, 80 and over">
|
|
<meta name="citation_keywords" content="Humans">
|
|
<meta name="citation_keywords" content="Review">
|
|
<link rel="schema.DC" href="http://purl.org/DC/elements/1.0/">
|
|
<meta name="DC.Title" content="Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma">
|
|
<meta name="DC.Type" content="Text">
|
|
<meta name="DC.Publisher" content="National Institute for Health and Care Excellence (NICE)">
|
|
<meta name="DC.Date" content="2024/11">
|
|
<meta name="DC.Identifier" content="https://www.ncbi.nlm.nih.gov/books/NBK612145/">
|
|
<meta name="og:title" content="Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma">
|
|
<meta name="og:type" content="book">
|
|
<meta name="og:url" content="https://www.ncbi.nlm.nih.gov/books/NBK612145/">
|
|
<meta name="og:site_name" content="NCBI Bookshelf">
|
|
<meta name="og:image" content="https://www.ncbi.nlm.nih.gov/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng245er1-lrg.png">
|
|
<meta name="twitter:card" content="summary">
|
|
<meta name="twitter:site" content="@ncbibooks">
|
|
<meta name="bk-non-canon-loc" content="/books/n/niceng245er1/toc/?report=reader">
|
|
<link rel="canonical" href="https://www.ncbi.nlm.nih.gov/books/NBK612145/">
|
|
<link href="https://fonts.googleapis.com/css?family=Archivo+Narrow:400,700,400italic,700italic&subset=latin" rel="stylesheet" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/libs.min.css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/jatsreader/ptpmc_3.22/css/jr.min.css">
|
|
<meta name="format-detection" content="telephone=no">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books.min.css" type="text/css">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css//books_print.min.css" type="text/css" media="print">
|
|
<link rel="stylesheet" href="/corehtml/pmc/css/bookshelf/2.26/css/books_reader.min.css" type="text/css">
|
|
<style type="text/css">p a.figpopup{display:inline !important} .bk_tt {font-family: monospace} .first-line-outdent .bk_ref {display: inline} .body-content h2, .body-content .h2 {border-bottom: 1px solid #97B0C8} .body-content h2.inline {border-bottom: none} a.page-toc-label , .jig-ncbismoothscroll a {text-decoration:none;border:0 !important} .temp-labeled-list .graphic {display:inline-block !important} .temp-labeled-list img{width:100%}</style>
|
|
|
|
<link rel="shortcut icon" href="//www.ncbi.nlm.nih.gov/favicon.ico">
|
|
<meta name="ncbi_phid" content="CE8C318D7D6B5E91000000000034002F.m_5">
|
|
<meta name='referrer' content='origin-when-cross-origin'/><link type="text/css" rel="stylesheet" href="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/css/3852956/3849091.css"></head>
|
|
<body>
|
|
<!-- Book content! -->
|
|
|
|
|
|
<div id="jr" data-jr-path="/corehtml/pmc/jatsreader/ptpmc_3.22/"><div class="jr-unsupported"><table class="modal"><tr><td><span class="attn inline-block"></span><br />Your browser does not support the NLM PubReader view.<br />Go to <a href="/pmc/about/pr-browsers/">this page</a> to see a list of supported browsers<br />or return to the <br /><a href="/books/NBK612145/?report=classic">regular view</a>.</td></tr></table></div><div id="jr-ui" class="hidden"><nav id="jr-head"><div class="flexh tb"><div id="jr-tb1"><a id="jr-links-sw" class="hidden" title="Links"><svg xmlns="http://www.w3.org/2000/svg" version="1.1" x="0px" y="0px" viewBox="0 0 70.6 85.3" style="enable-background:new 0 0 70.6 85.3;vertical-align:middle" xml:space="preserve" width="24" height="24">
|
|
<style type="text/css">.st0{fill:#939598;}</style>
|
|
<g>
|
|
<path class="st0" d="M36,0C12.8,2.2-22.4,14.6,19.6,32.5C40.7,41.4-30.6,14,35.9,9.8"></path>
|
|
<path class="st0" d="M34.5,85.3c23.2-2.2,58.4-14.6,16.4-32.5c-21.1-8.9,50.2,18.5-16.3,22.7"></path>
|
|
<path class="st0" d="M34.7,37.1c66.5-4.2-4.8-31.6,16.3-22.7c42.1,17.9,6.9,30.3-16.4,32.5h1.7c-66.2,4.4,4.8,31.6-16.3,22.7 c-42.1-17.9-6.9-30.3,16.4-32.5"></path>
|
|
</g>
|
|
</svg> Books</a></div><div class="jr-rhead f1 flexh"></div><div id="jr-tb2"><a id="jr-bkhelp-sw" class="btn wsprkl hidden" title="Help with NLM PubReader">?</a><a id="jr-help-sw" class="btn wsprkl hidden" title="Settings and typography in NLM PubReader"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 512 512" preserveAspectRatio="none"><path d="M462,283.742v-55.485l-29.981-10.662c-11.431-4.065-20.628-12.794-25.274-24.001 c-0.002-0.004-0.004-0.009-0.006-0.013c-4.659-11.235-4.333-23.918,0.889-34.903l13.653-28.724l-39.234-39.234l-28.72,13.652 c-10.979,5.219-23.68,5.546-34.908,0.889c-0.005-0.002-0.01-0.003-0.014-0.005c-11.215-4.65-19.933-13.834-24-25.273L283.741,50 h-55.484l-10.662,29.981c-4.065,11.431-12.794,20.627-24.001,25.274c-0.005,0.002-0.009,0.004-0.014,0.005 c-11.235,4.66-23.919,4.333-34.905-0.889l-28.723-13.653l-39.234,39.234l13.653,28.721c5.219,10.979,5.545,23.681,0.889,34.91 c-0.002,0.004-0.004,0.009-0.006,0.013c-4.649,11.214-13.834,19.931-25.271,23.998L50,228.257v55.485l29.98,10.661 c11.431,4.065,20.627,12.794,25.274,24c0.002,0.005,0.003,0.01,0.005,0.014c4.66,11.236,4.334,23.921-0.888,34.906l-13.654,28.723 l39.234,39.234l28.721-13.652c10.979-5.219,23.681-5.546,34.909-0.889c0.005,0.002,0.01,0.004,0.014,0.006 c11.214,4.649,19.93,13.833,23.998,25.271L228.257,462h55.484l10.595-29.79c4.103-11.538,12.908-20.824,24.216-25.525 c0.005-0.002,0.009-0.004,0.014-0.006c11.127-4.628,23.694-4.311,34.578,0.863l28.902,13.738l39.234-39.234l-13.66-28.737 c-5.214-10.969-5.539-23.659-0.886-34.877c0.002-0.005,0.004-0.009,0.006-0.014c4.654-11.225,13.848-19.949,25.297-24.021 L462,283.742z M256,331.546c-41.724,0-75.548-33.823-75.548-75.546s33.824-75.547,75.548-75.547 c41.723,0,75.546,33.824,75.546,75.547S297.723,331.546,256,331.546z"></path></svg></a><a id="jr-fip-sw" class="btn wsprkl hidden" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-cmap-sw" class="btn wsprkl hidden" title="Table of Contents"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,20h10v8H20V20zM36,20h44v8H36V20zM20,37.33h10v8H20V37.33zM36,37.33h44v8H36V37.33zM20,54.66h10v8H20V54.66zM36,54.66h44v8H36V54.66zM20,72h10v8 H20V72zM36,72h44v8H36V72z"></path></svg></a></div></div></nav><nav id="jr-dash" class="noselect"><nav id="jr-dash" class="noselect"><div id="jr-pi" class="hidden"><a id="jr-pi-prev" class="hidden" title="Previous page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M75,30 c-80,60 -80,0 0,60 c-30,-60 -30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Prev</text></svg></a><div class="pginfo">Page <i class="jr-pg-pn">0</i> of <i class="jr-pg-lp">0</i></div><a id="jr-pi-next" class="hidden" title="Next page"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M25,30c80,60 80,0 0,60 c30,-60 30,0 0,-60"></path><text x="20" y="28" textLength="60" style="font-size:25px">Next</text></svg></a></div><div id="jr-is-tb"><a id="jr-is-sw" class="btn wsprkl hidden" title="Switch between Figures/Tables strip and Progress bar"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><rect x="10" y="40" width="20" height="20"></rect><rect x="40" y="40" width="20" height="20"></rect><rect x="70" y="40" width="20" height="20"></rect></svg></a></div><nav id="jr-istrip" class="istrip hidden"><a id="jr-is-prev" href="#" class="hidden" title="Previous"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M80,40 60,65 80,90 70,90 50,65 70,40z M50,40 30,65 50,90 40,90 20,65 40,40z"></path><text x="35" y="25" textLength="60" style="font-size:25px">Prev</text></svg></a><a id="jr-is-next" href="#" class="hidden" title="Next"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M20,40 40,65 20,90 30,90 50,65 30,40z M50,40 70,65 50,90 60,90 80,65 60,40z"></path><text x="15" y="25" textLength="60" style="font-size:25px">Next</text></svg></a></nav><nav id="jr-progress"></nav></nav></nav><aside id="jr-links-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">NCBI Bookshelf</div></div><div class="cnt lol f1"><a href="/books/">Home</a><a href="/books/browse/">Browse All Titles</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://www.facebook.com/sharer/sharer.php?u=https://www.ncbi.nlm.nih.gov/books/NBK612145/"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24" preserveAspectRatio="none"><g><path d="M 17.996,32L 12,32 L 12,16 l-4,0 l0-5.514 l 4-0.002l-0.006-3.248C 11.993,2.737, 13.213,0, 18.512,0l 4.412,0 l0,5.515 l-2.757,0 c-2.063,0-2.163,0.77-2.163,2.209l-0.008,2.76l 4.959,0 l-0.585,5.514L 18,16L 17.996,32z"></path></g></svg> Share on Facebook</a><a class="btn share" target="_blank" rel="noopener noreferrer" href="https://twitter.com/intent/tweet?url=https://www.ncbi.nlm.nih.gov/books/NBK612145/&text=Evidence%20reviews%20for%20diagnostic%20test%20accuracy%20of%20spirometry%20in%20people%20suspected%20of%20asthma"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 33 33" style="vertical-align:middle" width="24" height="24"><g><path d="M 32,6.076c-1.177,0.522-2.443,0.875-3.771,1.034c 1.355-0.813, 2.396-2.099, 2.887-3.632 c-1.269,0.752-2.674,1.299-4.169,1.593c-1.198-1.276-2.904-2.073-4.792-2.073c-3.626,0-6.565,2.939-6.565,6.565 c0,0.515, 0.058,1.016, 0.17,1.496c-5.456-0.274-10.294-2.888-13.532-6.86c-0.565,0.97-0.889,2.097-0.889,3.301 c0,2.278, 1.159,4.287, 2.921,5.465c-1.076-0.034-2.088-0.329-2.974-0.821c-0.001,0.027-0.001,0.055-0.001,0.083 c0,3.181, 2.263,5.834, 5.266,6.438c-0.551,0.15-1.131,0.23-1.73,0.23c-0.423,0-0.834-0.041-1.235-0.118 c 0.836,2.608, 3.26,4.506, 6.133,4.559c-2.247,1.761-5.078,2.81-8.154,2.81c-0.53,0-1.052-0.031-1.566-0.092 c 2.905,1.863, 6.356,2.95, 10.064,2.95c 12.076,0, 18.679-10.004, 18.679-18.68c0-0.285-0.006-0.568-0.019-0.849 C 30.007,8.548, 31.12,7.392, 32,6.076z"></path></g></svg> Share on Twitter</a></div></aside><aside id="jr-cmap-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">In Page Navigation</div></div><div class="cnt lol f1"><a href="/books/n/niceercollect/?report=reader">NICE Evidence Reviews Collection</a><a class="current">Title Information</a></div></aside><aside id="jr-help-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Settings</div></div><div class="cnt f1"><div id="jr-typo-p" class="typo"><div><a class="sf btn wsprkl">A-</a><a class="lf btn wsprkl">A+</a></div><div><a class="bcol-auto btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 200 100" preserveAspectRatio="none"><text x="10" y="70" style="font-size:60px;font-family: Trebuchet MS, ArialMT, Arial, sans-serif" textLength="180">AUTO</text></svg></a><a class="bcol-1 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M15,25 85,25zM15,40 85,40zM15,55 85,55zM15,70 85,70z"></path></svg></a><a class="bcol-2 btn wsprkl"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 100 100" preserveAspectRatio="none"><path d="M5,25 45,25z M55,25 95,25zM5,40 45,40z M55,40 95,40zM5,55 45,55z M55,55 95,55zM5,70 45,70z M55,70 95,70z"></path></svg></a></div></div><div class="lol"><a class="" href="/books/NBK612145/?report=classic">Switch to classic view</a><a href="/books/n/niceng245er1/pdf/">PDF (1021K)</a><a href="/books/n/niceng245er1/toc/?report=printable">Print View</a></div></div></aside><aside id="jr-bkhelp-p" class="hidden flexv"><div class="tb sk-htbar flexh"><div><a class="jr-p-close btn wsprkl">Done</a></div><div class="title-text f1">Help</div></div><div class="cnt f1 lol"><a id="jr-helpobj-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/help.xml" href="">Help</a><a href="mailto:info@ncbi.nlm.nih.gov?subject=PubReader%20feedback%20%2F%20NBK612145%20%2F%20sid%3ACE8B5AF87C7FFCB1_0191SID%20%2F%20phid%3ACE8C318D7D6B5E91000000000034002F.4">Send us feedback</a><a id="jr-about-sw" data-path="/corehtml/pmc/jatsreader/ptpmc_3.22/" data-href="/corehtml/pmc/jatsreader/ptpmc_3.22/img/bookshelf/about.xml" href="">About PubReader</a></div></aside><aside id="jr-objectbox" class="thidden hidden"><div class="jr-objectbox-close wsprkl">✘</div><div class="jr-objectbox-inner cnt"><div class="jr-objectbox-drawer"></div></div></aside><nav id="jr-pm-left" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Previous Page</text></svg></nav><nav id="jr-pm-right" class="hidden"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 40 800" preserveAspectRatio="none"><text font-stretch="ultra-condensed" x="800" y="-15" text-anchor="end" transform="rotate(90)" font-size="18" letter-spacing=".1em">Next Page</text></svg></nav><nav id="jr-fip" class="hidden"><nav id="jr-fip-term-p"><input type="search" placeholder="search this page" id="jr-fip-term" autocorrect="off" autocomplete="off" /><a id="jr-fip-mg" class="wsprkl btn" title="Find"><svg xmlns="http://www.w3.org/2000/svg" viewBox="0 0 550 600" preserveAspectRatio="none"><path fill="none" stroke="#000" stroke-width="36" stroke-linecap="round" style="fill:#FFF" d="m320,350a153,153 0 1,0-2,2l170,170m-91-117 110,110-26,26-110-110"></path></svg></a><a id="jr-fip-done" class="wsprkl btn" title="Dismiss find">✘</a></nav><nav id="jr-fip-info-p"><a id="jr-fip-prev" class="wsprkl btn" title="Jump to previuos match">◀</a><button id="jr-fip-matches">no matches yet</button><a id="jr-fip-next" class="wsprkl btn" title="Jump to next match">▶</a></nav></nav></div><div id="jr-epub-interstitial" class="hidden"></div><div id="jr-content"><article data-type="main"><div class="main-content lit-style"><div class="fm-sec bkr_bottom_sep"><div class="bkr_thumb"><a href="https://www.nice.org.uk" title="National Institute for Health and Care Excellence (NICE)" class="img_link icnblk_img" ref="pagearea=logo&targetsite=external&targetcat=link&targettype=publisher"><img class="source-thumb" src="/corehtml/pmc/pmcgifs/bookshelf/thumbs/th-niceng245er1-lrg.png" alt="Cover of Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma" /></a></div><div class="bkr_bib"><h1 id="_NBK612145_"><span itemprop="name">Evidence reviews for diagnostic test accuracy of spirometry in people suspected of asthma</span></h1><div class="subtitle">Asthma: diagnosis, monitoring and chronic asthma management (update)</div><p><b>Evidence review A</b></p><p><i>NICE Guideline, No. 245</i></p><div class="half_rhythm">London: <a href="https://www.nice.org.uk" ref="pagearea=meta&targetsite=external&targetcat=link&targettype=publisher"><span itemprop="publisher">National Institute for Health and Care Excellence (NICE)</span></a>; <span itemprop="datePublished">2024 Nov</span>.<div class="small">ISBN-13: <span itemprop="isbn">978-1-4731-6614-1</span></div></div><div><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN 2024.</div></div><div class="bkr_clear"></div></div><div id="niceng245er1.s1"><h2 id="_niceng245er1_s1_">1. Spirometry</h2><div id="niceng245er1.s1.1"><h3>1.1. Review question</h3><p>In people under investigation for asthma, what is the diagnostic test accuracy and clinical and cost-effectiveness of spirometry in diagnosing asthma?</p><div id="niceng245er1.s1.1.1"><h4>1.1.1. Introduction</h4><p>Asthma can be a difficult condition to diagnose, and it is not clear which tests are most useful in supporting a diagnosis. Spirometry is a measure of lung function. The procedure involves blowing under maximal effort into an instrument (spirometer), the majority of which nowadays provide calculated measurements of air flows and volumes. These measurements can then be used to quantify airflow obstruction (usually due to narrowing of the airways, as seen typically in uncontrolled asthma) and restriction (not typically seen in asthma, but in other lung disease such as pulmonary fibrosis). Spirometry is therefore potentially useful in establishing a diagnosis of asthma and this evidence review was carried out to determine its clinical and cost-effectiveness as a diagnostic test.</p></div><div id="niceng245er1.s1.1.2"><h4>1.1.2. Summary of the protocol</h4><p>For full details see the review protocol in <a href="#niceng245er1.appa">Appendix A</a>.</p><p>No test-and-treat evidence was found so only the diagnostic accuracy evidence was reported.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1tab1"><a href="/books/NBK612145/table/niceng245er1.tab1/?report=objectonly" target="object" title="Table 1" class="img_link icnblk_img" rid-ob="figobniceng245er1tab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.tab1"><a href="/books/NBK612145/table/niceng245er1.tab1/?report=objectonly" target="object" rid-ob="figobniceng245er1tab1">Table 1</a></h4><p class="float-caption no_bottom_margin">PICO characteristics of diagnostic accuracy review question. </p></div></div></div><div id="niceng245er1.s1.1.3"><h4>1.1.3. Methods and process</h4><p>This evidence review was developed using the methods and process described in <a href="https://www.nice.org.uk/process/pmg20/chapter/introduction-and-overview" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Developing NICE guidelines: the manual</a>. Methods specific to this review question are described in the review protocol in <a href="#niceng245er1.appa">Appendix A</a> and the <a href="/books/NBK612145/bin/NG245-methods.pdf">methods</a> document.</p><p>Declarations of interest were recorded according to <a href="https://www.nice.org.uk/about/who-we-are/policies-and-procedures" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">NICE’s conflicts of interest policy</a>.</p></div><div id="niceng245er1.s1.1.4"><h4>1.1.4. Diagnostic evidence</h4><div id="niceng245er1.s1.1.4.1"><h5>1.1.4.1. Included studies</h5><p>Six cross-sectional diagnostic studies were included in the review; (<a class="bibr" href="#niceng245er1.ref1" rid="niceng245er1.ref1">Bai, et al., 2023</a>, <a class="bibr" href="#niceng245er1.ref2" rid="niceng245er1.ref2">Bao, et al., 2021</a>, <a class="bibr" href="#niceng245er1.ref3" rid="niceng245er1.ref3">Eom, et al., 2020</a>, <a class="bibr" href="#niceng245er1.ref5" rid="niceng245er1.ref5">Louis, et al., 2023</a>, <a class="bibr" href="#niceng245er1.ref8" rid="niceng245er1.ref8">Nekoee, et al., 2020</a>, <a class="bibr" href="#niceng245er1.ref11" rid="niceng245er1.ref11">Smith, et al., 2004</a>) this is summarised in <a href="/books/NBK612145/table/niceng245er1.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er1tab2">Table 2</a> below. Evidence from these studies is summarised below in <a href="/books/NBK612145/table/niceng245er1.tab4/?report=objectonly" target="object" rid-ob="figobniceng245er1tab4">Table 4</a> and references in <a href="#niceng245er1.s1.rl.r1">1.3 References</a>. The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making. The committee set clinical decision thresholds for sensitivity as 0.10, below which a test would be of no clinical use, and 0.90, above which a test would be recommended. For specificity these thresholds were set as 0.50, below which a test would be of no clinical use, and 0.80, above which a test would be recommended.</p><p>See also the study selection flow chart in <a href="#niceng245er1.appc">Appendix C</a>, sensitivity and specificity forest plots in <a href="#niceng245er1.appe">Appendix E</a>, and study evidence tables in <a href="#niceng245er1.appd">Appendix D</a>.</p></div><div id="niceng245er1.s1.1.4.2"><h5>1.1.4.2. Excluded studies</h5><p>Five studies from the previous NICE guidance on this topic were excluded from the current review. Two of these studies were excluded due to not containing a relevant index test (FEV<sub>1</sub> only, not FEV<sub>1</sub>/FVC in an adult population), one due to using an inappropriate study design (index test and reference standard 18 months apart), one due to containing a population that was not relevant to the current review protocol (inhaled corticosteroid washout period 12 hours) and one not containing a reference standard that was relevant to the current review protocol (objective test without clinician diagnosis in a population with an unclear pre-test probability of asthma).</p><p>See the excluded studies list in <a href="#niceng245er1.apph">Appendix H</a>.</p></div></div><div id="niceng245er1.s1.1.5"><h4>1.1.5. Summary of studies included in the diagnostic evidence</h4><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1tab2"><a href="/books/NBK612145/table/niceng245er1.tab2/?report=objectonly" target="object" title="Table 2" class="img_link icnblk_img" rid-ob="figobniceng245er1tab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.tab2"><a href="/books/NBK612145/table/niceng245er1.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er1tab2">Table 2</a></h4><p class="float-caption no_bottom_margin">Summary of studies included in the evidence review. </p></div></div><p>See <a href="#niceng245er1.appd">Appendix D</a> for full evidence tables.</p></div><div id="niceng245er1.s1.1.6"><h4>1.1.6. Summary of the diagnostic evidence</h4><p>The assessment of the evidence quality was conducted with emphasis on test sensitivity and specificity as this was identified by the committee as the primary measure in guiding decision-making. The committee set clinical decision thresholds as sensitivity upper =0.90 and lower= 0.10 and specificity upper= 0.80 and lower= 0.50. Above these thresholds a test could be recommended, and below the lower a test would be deemed of no clinical use. No pooling was possible due to fewer than three studies reporting the same diagnostic threshold.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1tab3"><a href="/books/NBK612145/table/niceng245er1.tab3/?report=objectonly" target="object" title="Table 3" class="img_link icnblk_img" rid-ob="figobniceng245er1tab3"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.tab3"><a href="/books/NBK612145/table/niceng245er1.tab3/?report=objectonly" target="object" rid-ob="figobniceng245er1tab3">Table 3</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for spirometry in adults. </p></div></div><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1tab4"><a href="/books/NBK612145/table/niceng245er1.tab4/?report=objectonly" target="object" title="Table 4" class="img_link icnblk_img" rid-ob="figobniceng245er1tab4"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.tab4"><a href="/books/NBK612145/table/niceng245er1.tab4/?report=objectonly" target="object" rid-ob="figobniceng245er1tab4">Table 4</a></h4><p class="float-caption no_bottom_margin">Clinical evidence summary: diagnostic test accuracy for spirometry in children and young people. </p></div></div></div><div id="niceng245er1.s1.1.7"><h4>1.1.7. Economic evidence</h4><div id="niceng245er1.s1.1.7.1"><h5>1.1.7.1. Included studies</h5><p>No health economic studies were included.</p></div><div id="niceng245er1.s1.1.7.2"><h5>1.1.7.2. Excluded studies</h5><p>No relevant health economic studies were excluded due to assessment of limited applicability or methodological limitations.</p><p>See also the health economic study selection flow chart in <a href="#niceng245er1.appf">Appendix F</a>.</p></div></div><div id="niceng245er1.s1.1.8"><h4>1.1.8. Summary of included economic evidence</h4><p>None</p></div><div id="niceng245er1.s1.1.9"><h4>1.1.9. Economic model</h4><p>A health economic model was conducted focusing on sequences and combinations of diagnostic tests. This is reported in evidence review 1.11.</p></div><div id="niceng245er1.s1.1.10"><h4>1.1.10. Unit costs</h4><p>Relevant unit costs are provided below to aid consideration of cost effectiveness.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1tab5"><a href="/books/NBK612145/table/niceng245er1.tab5/?report=objectonly" target="object" title="Table 5" class="img_link icnblk_img" rid-ob="figobniceng245er1tab5"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.tab5"><a href="/books/NBK612145/table/niceng245er1.tab5/?report=objectonly" target="object" rid-ob="figobniceng245er1tab5">Table 5</a></h4><p class="float-caption no_bottom_margin">Spirometry per-test cost. </p></div></div></div><div id="niceng245er1.s1.1.11"><h4>1.1.11. Evidence statements</h4><div id="niceng245er1.s1.1.11.1"><h5>Economic</h5><ul><li class="half_rhythm"><div>No relevant economic evaluations were identified.</div></li></ul></div></div></div><div id="niceng245er1.s1.2"><h3>1.2. The committee's discussion and interpretation of the evidence</h3><div id="niceng245er1.s1.2.1"><h4>1.2.1. The outcomes that matter most</h4><div id="niceng245er1.s1.2.1.1"><h5>Test and treat</h5><p>The outcomes considered for this review were: severe asthma exacerbations, mortality, quality of life, asthma control, hospital admissions, reliever/rescue medication use, lung function (change in FEV1 or morning PEF – average over at least 7 days for morning PEF), adverse events (linear growth, pneumonia frequency, adrenal insufficiency, bone mineral density), inflammatory markers; exhaled nitric oxide (continuous outcome at ≥8 weeks). For the purposes of decision making, all outcomes were considered equally important and were therefore rated as critical by the committee. No relevant evidence was identified for any of the outcomes.</p></div><div id="niceng245er1.s1.2.1.2"><h5>Diagnostic accuracy</h5><p>The committee considered the diagnostic measures of sensitivity and specificity of the index test for diagnosing asthma as well as the positive and negative predictive values where these were reported by the studies. Equal emphasis was placed upon both sensitivity and specificity. Clinical decision thresholds were set by the committee as sensitivity/specificity 0.9 and 0.8 above which a test could be recommended and 0.1 and 0.5 below which a test is of no clinical use. The committee were interested in establishing whether there was an optimal cut-off value from spirometry readings with sufficiently high sensitivity and specificity to be useful in making a diagnosis of asthma, but also in whether there are cut-off values which could usefully help either rule in or rule out an asthma diagnosis.</p></div></div><div id="niceng245er1.s1.2.2"><h4>1.2.2. The quality of the evidence</h4><div id="niceng245er1.s1.2.2.1"><h5>Test and Treat studies</h5><p>No relevant clinical studies were identified comparing the clinical effectiveness of spirometry measures with physician diagnosis of asthma based on symptoms plus an objective test from any of the following: peak flow variability (e.g. more than 20% variability as indication of a positive test), bronchodilator reversibility (e.g. an improvement in FEV1 of more than or equal to 12% plus an increase in volume of more than or equal to 200mls as indication of a positive test), bronchial hyper-responsiveness (e.g. histamine or methacholine challenge test, cut-off value of PC20 less than or equal to 8mg/ml as indication of a positive test) or FeNO.</p></div><div id="niceng245er1.s1.2.2.2"><h5>Diagnostic accuracy studies</h5><p>Seven prospective cross-sectional studies were included in the diagnostic accuracy evidence for spirometry. One study was in children and young people and six studies were conducted in adults. The study conducted in children and young people reported two spirometric measures, FEV<sub>1</sub>, with positivity determined as 88.4% of predicted, and FEV<sub>1</sub>/FVC ratio with positivity determined as 85.3%. The evidence in adults was all for FEV<sub>1</sub>/FVC ratio, with cut-off values ranging from 70% to 84.76%.</p><p>The quality of the evidence for children and young people ranged from moderate to low as a result of downgrading due to index test indirectness, namely due to using cut-offs (chosen based on optimal threshold) that were different to the protocol-specified cut-offs. Additionally, some imprecision was seen in the specificity estimates for FEV<sub>1</sub> as a percentage of predicted values.</p><p>The quality of the evidence for the adult population was all very low quality. All evidence was downgraded by at least one increment due to risk of bias, most frequently due to concerns arising from the method of participant selection and a lack of clarity over blinding of assessors. Additionally, all evidence was downgraded by at least one increment due to indirectness. This was mostly due to reporting thresholds different to those specified in the review protocol, not reporting the standards the spirometry was performed to, or lacking clarity over the involvement of a clinician decision in the final asthma diagnosis.</p></div></div><div id="niceng245er1.s1.2.3"><h4>1.2.3. Benefits and harms</h4><div id="niceng245er1.s1.2.3.1"><h5>Diagnostic accuracy review:</h5><div id="niceng245er1.s1.2.3.1.1"><h5>Children and young people</h5><p>Clinical evidence for the diagnostic accuracy of FEV<sub>1</sub> in children and young people using a cut-off of 88.4% predicted to detect asthma showed a moderate sensitivity (0.68) and specificity (0.76) although there was some imprecision in the effect for specificity with the upper limit of the confidence interval crossing the higher threshold set for specificity. In the same population, FEV<sub>1</sub>/FVC ratio with a cut-off of 85.3% also showed a moderate sensitivity (0.73) and specificity (0.65) for asthma. The committee noted that the cut-off for FEV<sub>1</sub> was not the same as the widely accepted cut-off value for defining airflow obstruction as specified in the review protocol (<70%). However, although widely used, the figure of <70% is known to be an oversimplification, and preference now is to use standardised residual values if these are available. This approach would set a higher cut-off value as the definition of airflow obstruction in children.</p></div><div id="niceng245er1.s1.2.3.1.2"><h5>Adults</h5><p>Low to very low-quality evidence from two studies reported FEV<sub>1</sub>/FVC ratio with a cut-off of 70% in adults, showing low sensitivities ranging from 0.30–0.35 and very high specificities ranging from 0.95–1.00. Evidence was downgraded by at least one increment due to risk of bias arising from concerns surrounding the method of participant selection and/or a lack of clarity over the blinding of assessors. Evidence from one study was downgraded by two increments due to indirectness arising from not reporting the standard spirometry was conducted to and including a mixed population of adults and children and young people.</p><p>Very low-quality evidence from two studies reported FEV<sub>1</sub>/FVC ratio with a cut-off of 75% in adults, showing low-moderate sensitivities ranging from 0.39–0.49 and high specificities ranging from 0.83–0.90. Evidence from both studies was downgraded by two increments due to risk of bias arising from concerns surrounding the method of participant selection and a lack of clarity over the blinding of assessors. Furthermore, all evidence was downgraded by one increment due to using a cut-off that was different to those specified in the present review protocol (70% or LLN). One of these studies also reported the diagnostic accuracy of FEV<sub>1</sub>/FVC ratio with a cut-off of 78%, showing a moderate sensitivity of 0.54 and a moderate specificity of 0.79. This evidence was also of very low quality due to the aforementioned reasons.</p><p>A separate study reported FEV<sub>1</sub>/FVC ratio with a cut-off of 76% in adults, showing a moderate sensitivity of 0.51 and a moderate specificity of 0.76, albeit with very low certainty. This evidence was limited due to very serious risk of bias arising from an unclear method of recruitment, unclear blinding, and not all participants having the same reference standard due to some receiving a bronchodilator reversibility test, whilst others were diagnosed with a methacholine challenge test. Furthermore, this study was downgraded due to indirectness as a result of not reporting the protocol used for the spirometry measurements and because it was not clear whether the reference standard involved a clinician decision.</p><p>Very low-quality evidence from one study reported FEV<sub>1</sub>/FVC ratio with a cut-off of 80%, showing a moderate sensitivity of 0.47 and a high specificity of 0.80. Whilst this evidence suggests that this is a valuable test for ruling asthma in, the committee were aware that the data was not without limitations, largely due to the small sample of 47 participants. Additionally, serious risk of bias arose due to a lack of blinding, and indirectness was present due to incomplete reporting of the protocol used for the spirometry measurements and the inclusion of a mixture of children/young people and adults.</p><p>Very low-quality evidence from one study reported FEV<sub>1</sub>/FVC ratio with a cut-off of 78.79% in adults, showing a moderate sensitivity of 0.52 and a high specificity of 0.83. This evidence was limited due to risk of bias arising from an unclear method of recruitment and unclear blinding, in addition to indirectness due to using a cut-off that was different to that specified in this review protocol (<70% or <LLN).</p><p>Very low-quality evidence from one study reported FEV<sub>1</sub>/FVC ratio with a cut-off of 84.76% in adults, showing a moderate sensitivity of 0.66 and a moderate specificity of 0.68. This evidence was limited due to risk of bias arising from an unclear recruitment method and unclear blinding, as well as indirectness due to not reporting the protocol used for the spirometry measurements and using a cut-off that was different to that specified in this review protocol (<70% or <LLN).</p><p>Low quality evidence from a single study reported the diagnostic accuracy of FEV<sub>1</sub>/FVC ratio using three different cut-offs that included LLN. Using LLN as a single cut-off resulted in a moderate sensitivity of 0.37 and a very high specificity of 0.96. Including 70% as an alternative to LLN increased sensitivity to 0.39 whilst maintaining specificity at 0.96. Using a different approach, with LLN as the cut-off in combination with reduced FEV<sub>1</sub>, resulted in a moderate sensitivity of 0.47 and a very high specificity of 0.94. All of this evidence was at very high risk of bias due to a lack of clarity surrounding the participant selection method, and a lack of blinding of the index test and reference standard. Nonetheless, all three of these cut-offs met the clinical decision making threshold for specificity, suggesting that these are suitable thresholds for ruling asthma in, but with poor sensitivity suggesting they are not suitable for ruling a diagnosis out.</p><p>Overall, the committee agreed the evidence was poor both in terms of quality and quantity with little data in adults meeting the review protocol. However, the conclusions of the included evidence are in keeping with the committee’s clinical experience in showing high specificity but low sensitivity of spirometry as a test for asthma. This is predictable since asthma is a disease of variable airflow obstruction, and because of that variability many people with asthma will have normal spirometry at the time the test is performed. The committee noted that in clinical practice spirometry readings are not taken in isolation but in combination with other diagnostic tests in order to diagnose asthma. The committee therefore recommended against using spirometry as a standalone test for asthma but emphasised the importance of spirometry in assessing other causes of breathlessness which must be distinguished from asthma, in particular COPD which is a common alternate cause of breathlessness in adults.</p><p>Although some evidence of moderate quality was available for children, the committee did not feel able to recommend the routine use of spirometry as a standalone test. A factor in this was due to the difficulty many children have in performing spirometry, especially at younger ages. Furthermore, many staff in general practice are not trained in paediatric spirometry. Given the aforementioned difficulties of conducting spirometry in paediatric populations, testing would require that children are referred to secondary care (until such times as diagnostic hubs are widely available). Despite the practical arguments presented against spirometry for children and young people, the committee did not wish to recommend against the use of spirometry. The committee agreed that spirometry may have a role when children are referred to secondary care, particularly in older children.</p></div></div></div><div id="niceng245er1.s1.2.4"><h4>1.2.4. Cost effectiveness and resource use</h4><p>No relevant published health economic analyses were identified for this review question. The unit cost of spirometry was presented to aid committee consideration of cost effectiveness. The unit cost of undertaking a spirometry for diagnostic purposes was £22.93 and included the health care professional time for conducting the test and interpreting the result (£21.13) and the equipment and consumables required for the spirometry (£1.80).</p><p>With regards to staff time, the committee agreed that the test could be undertaken and interpreted by a general practice nurse (band 5) trained and accredited in spirometry testing. There was discussion that in some settings the spirometry could be conducted and interpreted by a health care assistant (band 3 or 4) who is fully trained and accredited to do so, but the committee agreed this is less common. The committee discussed the time required for the practice nurse to undertake the test and interpret the results and noted that this can be variable depending on the person’s age and ability as well as the health care professional’s experience in conducting the test. The committee agreed that on average 20 minutes was appropriate. The training and accreditation required for conducting this test can take considerable time, the training course is 6 months and re-accreditation is required every 3 years. The unit cost for a practice nurse used in the costing does include pre-registration qualifications but does not necessarily include this training.</p><p>In terms of equipment and consumables, the per test cost of the spirometer and calibration syringe were calculated by assuming that the equipment would last for 7 years and used on average 2100 times during that period (this assumes 300 tests conducted a year). Annuitisation was undertaken assuming a rate of 3.5%. In addition to these capital costs, the unit cost of a mouthpiece (including a bacterial filter) and thermal printer paper were included.</p><p>The committee considered spirometry alongside or in combination with a variety of other tests for asthma within a diagnostic algorithm for both adults and children (see evidence review 1.11). Spirometry with bronchodilator reversibility was found to be a cost-effective test to be included in the diagnostic algorithm for adults and recommended in both adults and children (see <a href="#niceng245er1.s1.2">evidence review 1.2</a>).</p></div><div id="niceng245er1.s1.2.5"><h4>1.2.5. Other factors the committee took into account</h4><p>The role of spirometry in diagnosing asthma cannot be divorced from its role in assessing people with symptoms which are suggestive of asthma but also compatible with other diagnoses. This is particularly important in adults in relation to COPD, which is excluded by normal spirometry.</p><p>In children, as noted above, there are practical problems in obtaining diagnostic spirometry in primary care because the majority of practices do not have staff members trained in paediatric spirometry.</p></div><div id="niceng245er1.s1.2.6"><h4>1.2.6. Recommendations supported by this evidence review</h4><p><a href="#niceng245er1.s1.2.2">Recommendations 1.2.2</a> and <a href="#niceng245er1.s1.2.6">1.2.6</a>.</p></div></div><div id="niceng245er1.s1.rl.r1"><h3>1.3. References</h3><ul class="simple-list"><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref1">Bai
|
|
H, Shi
|
|
C, Yu
|
|
S, et al (2023) A comparative study on the value of lower airway exhaled nitric oxide combined with small airway parameters for diagnosing cough-variant asthma
|
|
Therapeutic Advances in Respiratory Disease
|
|
17: 17534666231181259.
|
|
[<a href="/pmc/articles/PMC10278400/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC10278400</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/37326344" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 37326344</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref2">Bao
|
|
W, Zhang
|
|
X, Yin
|
|
J, et al (2021) Small-Airway Function Variables in Spirometry, Fractional Exhaled Nitric Oxide, and Circulating Eosinophils Predicted Airway Hyperresponsiveness in Patients with Mild Asthma
|
|
Journal of Asthma and Allergy
|
|
14: 415–426.
|
|
[<a href="/pmc/articles/PMC8071078/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8071078</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33907426" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33907426</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref3">Eom
|
|
S-Y, Lee
|
|
JK, Lee
|
|
Y-J, et al (2020) Combining spirometry and fractional exhaled nitric oxide improves diagnostic accuracy for childhood asthma
|
|
The clinical respiratory journal
|
|
14 (1): 21–28.
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31608556" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31608556</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref4">Jones
|
|
K, Birch
|
|
S, Dargan
|
|
A, et al
|
|
Unit Costs of Health and Social Care
|
|
2022. Available from: <a href="https://www.pssru.ac.uk/unitcostsreport/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://www<wbr style="display:inline-block"></wbr>​.pssru.ac.uk/unitcostsreport/</a> Last accessed: 26/04/2024.</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref5">Louis
|
|
G, Schleich
|
|
F, Guillaume
|
|
M, et al (2023) Development and validation of a predictive model combining patient-reported outcome measures, spirometry and exhaled nitric oxide fraction for asthma diagnosis
|
|
ERJ Open Research
|
|
9 (1). [<a href="/pmc/articles/PMC9900444/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC9900444</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/36755965" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 36755965</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref6">MicroDirect. MicroLab: Operating Manual. 2019. Available from: <a href="https://mdspiro.com/wp-content/uploads/2020/04/ML3500-MicroLab-Operators-Manual.pdf" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">https://mdspiro<wbr style="display:inline-block"></wbr>​.com/wp-content<wbr style="display:inline-block"></wbr>​/uploads/2020<wbr style="display:inline-block"></wbr>​/04/ML3500-MicroLab-Operators-Manual<wbr style="display:inline-block"></wbr>​.pdf</a></div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref7">National Institute for Health and Care Excellence. Developing NICE guidelines: the manual. . London. National Institute for Health and Care Excellence, 2014. Available from: <a href="http://www.nice.org.uk/article/PMG20/chapter/1%20Introduction%20and%20overview" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.nice.org.uk<wbr style="display:inline-block"></wbr>​/article/PMG20/chapter<wbr style="display:inline-block"></wbr>​/1%20Introduction%20and%20overview</a> [<a href="https://pubmed.ncbi.nlm.nih.gov/26677490" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26677490</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref8">Nekoee
|
|
H, Graulich
|
|
E, Schleich
|
|
F, et al (2020) Are type-2 biomarkers of any help in asthma diagnosis?
|
|
ERJ Open Res
|
|
6 (2). [<a href="/pmc/articles/PMC7369447/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7369447</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32714964" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32714964</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref9">NHS Supply Chain Catalogue. NHS Supply Chain, 2022. Available from: <a href="http://www.supplychain.nhs.uk/" ref="pagearea=cite-ref&targetsite=external&targetcat=link&targettype=uri">http://www<wbr style="display:inline-block"></wbr>​.supplychain.nhs.uk/</a></div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref10">Simpson
|
|
A, Drake
|
|
S, Healy
|
|
L, et al
|
|
Asthma Diagnosis: A Comparison of Established Diagnostic Guidelines in Adults with Respiratory Symptoms. 2024. [<a href="/pmc/articles/PMC11408836/" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC11408836</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/39296585" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 39296585</span></a>]</div></p></li><li class="half_rhythm"><p><div class="bk_ref" id="niceng245er1.ref11">Smith
|
|
AD, Cowan
|
|
JO, Filsell
|
|
S, et al (2004) Diagnosing asthma: comparisons between exhaled nitric oxide measurements and conventional tests
|
|
American Journal of Respiratory and Critical Care Medicine
|
|
169 (4): 473–478.
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/14644933" ref="pagearea=cite-ref&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 14644933</span></a>]</div></p></li></ul></div></div><div id="appendixesappgroup1"><h2 id="_appendixesappgroup1_">Appendices</h2><div id="niceng245er1.appa"><h3>Appendix A. Review protocols</h3><p id="niceng245er1.appa.et1"><a href="/books/NBK612145/bin/niceng245er1-appa-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Diagnostic test accuracy of spirometry</a><span class="small"> (PDF, 254K)</span></p><p id="niceng245er1.appa.et2"><a href="/books/NBK612145/bin/niceng245er1-appa-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economic review protocol</a><span class="small"> (PDF, 129K)</span></p></div><div id="niceng245er1.appb"><h3>Appendix B. Literature search strategies</h3><p>In people under investigation for asthma, what is the diagnostic test accuracy and clinical and cost-effectiveness of spirometry in diagnosing asthma?</p><p id="niceng245er1.appb.et1"><a href="/books/NBK612145/bin/niceng245er1-appb-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical search literature search strategy</a><span class="small"> (PDF, 209K)</span></p><p id="niceng245er1.appb.et2"><a href="/books/NBK612145/bin/niceng245er1-appb-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Health economics literature search strategy</a><span class="small"> (PDF, 167K)</span></p></div><div id="niceng245er1.appc"><h3>Appendix C. Evidence study selection</h3><p id="niceng245er1.appc.et1"><a href="/books/NBK612145/bin/niceng245er1-appc-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Diagnostic test accuracy of spirometry</a><span class="small"> (PDF, 104K)</span></p><p id="niceng245er1.appc.et2"><a href="/books/NBK612145/bin/niceng245er1-appc-et2.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Clinical and cost effectiveness of spirometry</a><span class="small"> (PDF, 94K)</span></p></div><div id="niceng245er1.appd"><h3>Appendix D. Evidence tables</h3><div id="niceng245er1.appd.s1"><h4>Diagnostic test accuracy of spirometry</h4><p id="niceng245er1.appd.et1"><a href="/books/NBK612145/bin/niceng245er1-appd-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (344K)</span></p></div><div id="niceng245er1.appd.s2"><h4>Clinical and cost effectiveness of spirometry</h4><p>No clinical evidence identified.</p></div></div><div id="niceng245er1.appe"><h3>Appendix E. Forest plots</h3><div id="niceng245er1.appe.s1"><h4>Diagnostic test accuracy of spirometry</h4><p id="niceng245er1.appe.et1"><a href="/books/NBK612145/bin/niceng245er1-appe-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Download PDF</a><span class="small"> (123K)</span></p></div><div id="niceng245er1.appe.s2"><h4>Clinical and cost effectiveness of spirometry</h4><p>No clinical evidence identified.</p></div></div><div id="niceng245er1.appf"><h3>Appendix F. Economic evidence study selection</h3><p id="niceng245er1.appf.et1"><a href="/books/NBK612145/bin/niceng245er1-appf-et1.pdf" class="bk_dwnld_icn bk_dwnld_pdf">Figure 15. Flow chart of health economic study selection for the guideline</a><span class="small"> (PDF, 178K)</span></p></div><div id="niceng245er1.appg"><h3>Appendix G. Economic evidence tables</h3><p>None.</p></div><div id="niceng245er1.apph"><h3>Appendix H. Excluded studies</h3><div id="niceng245er1.apph.s1"><h4>Clinical studies</h4><div id="niceng245er1.apph.s1.1"><h5>Diagnostic test accuracy of spirometry</h5><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1apphtab1"><a href="/books/NBK612145/table/niceng245er1.apph.tab1/?report=objectonly" target="object" title="Table 9" class="img_link icnblk_img" rid-ob="figobniceng245er1apphtab1"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.apph.tab1"><a href="/books/NBK612145/table/niceng245er1.apph.tab1/?report=objectonly" target="object" rid-ob="figobniceng245er1apphtab1">Table 9</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the clinical review. </p></div></div></div><div id="niceng245er1.apph.s1.2"><h5>Clinical and cost effectiveness of spirometry</h5><div id="niceng245er1.apph.s1.2.1"><h5>Studies excluded from the clinical review</h5><p>No studies identified for full text screening.</p></div></div></div><div id="niceng245er1.apph.s2"><h4>Health Economic studies</h4><p>Published health economic studies that met the inclusion criteria (relevant population, comparators, economic study design, published 2006 or later and not from non-OECD country or USA) but that were excluded following appraisal of applicability and methodological quality are listed below. See the health economic protocol for more details.</p><div class="iconblock whole_rhythm clearfix ten_col table-wrap" id="figniceng245er1apphtab2"><a href="/books/NBK612145/table/niceng245er1.apph.tab2/?report=objectonly" target="object" title="Table 10" class="img_link icnblk_img" rid-ob="figobniceng245er1apphtab2"><img class="small-thumb" src="/corehtml/pmc/css/bookshelf/2.26/img/table-icon.gif" alt="Table Icon" /></a><div class="icnblk_cntnt"><h4 id="niceng245er1.apph.tab2"><a href="/books/NBK612145/table/niceng245er1.apph.tab2/?report=objectonly" target="object" rid-ob="figobniceng245er1apphtab2">Table 10</a></h4><p class="float-caption no_bottom_margin">Studies excluded from the health economic review. </p></div></div></div></div></div></div><div class="fm-sec"><div><p>Final</p></div><div><p>BTS/NICE/SIGN collaborative guideline NG245</p><p>Developed by BTS, NICE and SIGN</p></div><div><p><b>Disclaimer</b>: The recommendations in this collaborative guideline represent the view of BTS, NICE and SIGN, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or service users. The recommendations in this guideline are not mandatory and the guideline does not override the responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or their carer or guardian.</p><p>Local commissioners and/or providers have a responsibility to enable the guideline to be applied when individual health professionals and their patients or service users wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with compliance with those duties.</p><p>This collaborative guideline covers health and care in England and Scotland. Decisions on how they apply in other UK countries are made by ministers in the <a href="http://wales.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Welsh Government</a> and <a href="http://www.northernireland.gov.uk/" ref="pagearea=body&targetsite=external&targetcat=link&targettype=uri">Northern Ireland Executive</a>. This collaborative guideline is subject to regular review and may be updated or withdrawn.</p></div><div class="half_rhythm"><a href="/books/about/copyright/">Copyright</a> © BTS, NICE and SIGN 2024.</div><div class="small"><span class="label">Bookshelf ID: NBK612145</span><span class="label">PMID: <a href="https://pubmed.ncbi.nlm.nih.gov/39965062" title="PubMed record of this title" ref="pagearea=meta&targetsite=entrez&targetcat=link&targettype=pubmed">39965062</a></span></div></div><div class="small-screen-prev"></div><div class="small-screen-next"></div></article><article data-type="table-wrap" id="figobniceng245er1tab1"><div id="niceng245er1.tab1" class="table"><h3><span class="label">Table 1</span><span class="title">PICO characteristics of diagnostic accuracy review question</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.tab1_lrgtbl__"><table><tbody><tr><th id="hd_b_niceng245er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Population</th><td headers="hd_b_niceng245er1.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>People with suspected asthma (presenting with respiratory symptoms).</p>
|
|
<p>Ages stratified into the following 2 groups:<ul><li class="half_rhythm"><div>Children and young people (5–16 years old)</div></li><li class="half_rhythm"><div>Adults (≥17 years old)</div></li></ul></p>
|
|
<p>Exclusion:</p>
|
|
<p>Children under 5 years old</p>
|
|
<p>People on steroid inhalers (washout period minimum of 4 weeks for inclusion)</p>
|
|
</td></tr><tr><th id="hd_b_niceng245er1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Target condition</th><td headers="hd_b_niceng245er1.tab1_1_1_2_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td></tr><tr><th id="hd_b_niceng245er1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Index test</th><td headers="hd_b_niceng245er1.tab1_1_1_3_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Spirometry measures (report separately)<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>1.</dt><dd><p class="no_top_margin">Airflow obstruction, defined as either:<ol class="lower-alpha"><li class="half_rhythm"><div>FEV1/FVC ratio (<70%)</div></li><li class="half_rhythm"><div>FEV1/FVC ratio < lower limit of normal (LLN)</div></li></ol></p></dd></dl></dl></p>
|
|
<p>Secondary outcome (if no data for above): in children only:<dl class="temp-labeled-list"><dl class="bkr_refwrap"><dt>2.</dt><dd><p class="no_top_margin">Reduced FEV1, defined as either:<ol class="lower-alpha"><li class="half_rhythm"><div>< 80% predicted</div></li><li class="half_rhythm"><div>< LLN</div></li></ol></p></dd></dl></dl></p>
|
|
</td></tr><tr><th id="hd_b_niceng245er1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference standard</th><td headers="hd_b_niceng245er1.tab1_1_1_4_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Physician diagnosis of asthma based on symptoms plus an objective test from any one of the following:<ul><li class="half_rhythm"><div>peak flow variability (e.g. more than 20% variability as indication of a positive test)</div></li><li class="half_rhythm"><div>bronchodilator reversibility (e.g. an improvement in FEV1 of more than or equal to 12%, and an increase in volume of more than or equal to 200mls as indication of a positive test)</div></li><li class="half_rhythm"><div>bronchial hyper-responsiveness (e.g. histamine or methacholine challenge test, cut-off value of PC20 less than or equal to 8mg/ml as indication of a positive test)</div></li><li class="half_rhythm"><div>FeNO</div></li></ul></p>
|
|
<p>Where no evidence is available using the cut-off values specified above, evidence will be included from studies using a reference standard of physician diagnosis with an objective test using an alternative threshold.</p>
|
|
<p>Where no evidence is available from studies using physician diagnosis and an objective test, evidence will be included from studies using physician diagnosis based on symptoms alone, or patient report of a previous physician diagnosis.</p>
|
|
<p>Maximum time between index test and reference standard: 12 months</p>
|
|
</td></tr><tr><th id="hd_b_niceng245er1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Statistical measures</th><td headers="hd_b_niceng245er1.tab1_1_1_5_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnostic accuracy outcomes:<ul><li class="half_rhythm"><div>Sensitivity thresholds: upper 90, lower 10</div></li><li class="half_rhythm"><div>Specificity thresholds: upper 80, lower 50</div></li><li class="half_rhythm"><div>Raw data to calculate 2×2 tables to calculate sensitivity and specificity</div></li><li class="half_rhythm"><div>Negative predictive value (NPV), Positive predictive value (PPV)</div></li></ul></td></tr><tr><th id="hd_b_niceng245er1.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study design</th><td headers="hd_b_niceng245er1.tab1_1_1_6_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<ul><li class="half_rhythm"><div>Cross-sectional studies</div></li><li class="half_rhythm"><div>Cohort studies</div></li></ul>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng245er1tab2"><div id="niceng245er1.tab2" class="table"><h3><span class="label">Table 2</span><span class="title">Summary of studies included in the evidence review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Study</th><th id="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Population</th><th id="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Target condition</th><th id="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Index test</th><th id="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Reference standard</th><th id="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:bottom;">Comments</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bai 2023 (<a class="bibr" href="#niceng245er1.ref1" rid="niceng245er1.ref1">Bai et al., 2023</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with chronic cough (>8 weeks) attending a Pulmonary and Critical Care Department with an FEV1 >80% of predicted</p>
|
|
<p>N=283</p>
|
|
<p>Mean age (SD): CVA; 47.8 (15.9), nCVA; 44.6 (15.2) years</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Cough variant asthma vs non-asthma chronic cough</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>FEV1/FVC</p>
|
|
<p>Cut-off: 78.79% of predicted</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma as per Chinese diagnosis guidelines: chronic cough, often with significant night cough, positive bronchial provocation test and positive response to anti-asthma treatment</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cross-sectional study</p>
|
|
<p>Strata: Adults</p>
|
|
<p>ICS use: none within a month</p>
|
|
<p>Smoking status: non-smokers</p>
|
|
<p>Indirectness: downgraded by one increment due to index test (LLN not used as cut-off) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bao 2021 (<a class="bibr" href="#niceng245er1.ref2" rid="niceng245er1.ref2">Bao et al., 2021</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults with an FEV1 >80%, normal CT scan results and recurrent variable symptoms of dyspnoea, cough, wheeze or chest tightness for >8 weeks referred to a pulmonary outpatient clinic</p>
|
|
<p>N= 692</p>
|
|
<p>Mean age (SD): positive MCT; 43.90 (12.56), negative MCT: 43.80 (14.90)</p>
|
|
<p>China</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Airway hyperresponsiveness to methacholine</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>FEV1/FVC</p>
|
|
<p>Cut-off: 84.67% of predicted</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Airway hyperresponsiveness was diagnosed using methacholine challenge testing</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Retrospective cross-sectional study</p>
|
|
<p>Strata: adults</p>
|
|
<p>ICS use: none within a month</p>
|
|
<p>Smoking status: non-smokers</p>
|
|
<p>Indirectness: downgraded by two increments due to index test (LLN not used as cut-off) and reference standard (unclear clinician decision in diagnosis) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Eom 2020 (<a class="bibr" href="#niceng245er1.ref3" rid="niceng245er1.ref3">Eom et al., 2020</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Consecutive patients referred to an outpatient clinic for the diagnosis of asthma.</p>
|
|
<p>Inclusion criteria: 8–16 years old with respiratory symptoms for at least 1-month.</p>
|
|
<p>Exclusion criteria: symptoms of respiratory tract infection or other systemic or inflammatory disease, receiving inhaled short-acting β-2-agonists within 8 hours or receiving regular controller medication within a month</p>
|
|
<p>N= 275; mean age (range): 11.5 (10.7–12.3) years</p>
|
|
<p>South Korea</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Lung function assessed using ATS/ERS recommendations. %pred. FEV<sub>1</sub>, FEF25–75 and FEV<sub>1</sub>/FVC reported.</p>
|
|
<p>Cut-offs:</p>
|
|
<p>%pred. FEV<sub>1</sub>: 88.4%</p>
|
|
<p>FEV<sub>1</sub>/FVC: 85.3%</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Assessed by a paediatric pulmonologist after ≥6 months of follow-up. Asthma was diagnosed according to the Global Initiative for Asthma guidelines (symptoms and exacerbations)</p>
|
|
<p>Spirometry was used to determine presence of variable expiratory airflow limitation, which was confirmed by increase in FEV1 of more than 12% in response to a rapid-acting bronchodilator at any time during the follow-up period, increase in FEV1 of more than 12% from baseline after 4 weeks of anti-inflammatory treatment, and/or variation in FEV1 of more than 12% between visits</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cross-sectional study</p>
|
|
<p>Strata: Children and young people</p>
|
|
<p>ICS use: 1-month washout</p>
|
|
<p>Smoking status: 45.2% and 40.6% exposed to cigarette smoking in non-asthma and asthma groups, respectively</p>
|
|
<p>Indirectness: FEV<sub>1</sub>/FVC downgraded by one increment due to index test (LLN not used as cut-off) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Louis 2023 (<a class="bibr" href="#niceng245er1.ref5" rid="niceng245er1.ref5">Louis et al., 2023</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Adults seeking medical attention at an asthma clinic, in whom asthma was suspected</p>
|
|
<p>N= 303; mean age; 51 (16) years</p>
|
|
<p>Belgium</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>FEV<sub>1</sub>/FVC ratio</p>
|
|
<p>Cut-off: 75 and 78%</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma was diagnosed as per GINA guidelines, combining symptoms with bronchodilator reversibility and/or methacholine bronchial challenge tests</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cross-sectional study</p>
|
|
<p>Strata:</p>
|
|
<p>Age: Adults</p>
|
|
<p>Smoking status: Mixed</p>
|
|
<p>ICS use: Treatment naïve</p>
|
|
<p>Indirectness: Downgraded by one increment due to index test (cut-offs other than 70% or LLN used) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Nekoee 2020 (<a class="bibr" href="#niceng245er1.ref8" rid="niceng245er1.ref8">Nekoee et al., 2020</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Database record of patients who had been referred to an asthma clinic with respiratory symptoms suggestive of asthma by two respiratory physicians</p>
|
|
<p>N= 702; mean age: 51 years</p>
|
|
<p>Location not reported</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>FEV<sub>1</sub>/FVC</p>
|
|
<p>Cut-off: 76%</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma was diagnosed by a positive result with a bronchodilator test (≥12% and 200 mL) or methacholine challenge test (≥20% fall in FEV<sub>1</sub> with ⩽8 mg·mL<sup>−1</sup>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Retrospective cross-sectional study</p>
|
|
<p>Strata: Adults</p>
|
|
<p>ICS use: Treatment naïve</p>
|
|
<p>Smoking status: Mixed (57% never, 24% ex, 19% current</p>
|
|
<p>Indirectness: Downgraded by two increments due to index test (LLN or 70% not used as cut-offs) and reference standard (unclear clinician involvement in diagnosis) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Simpson 2024 (<a class="bibr" href="#niceng245er1.ref10" rid="niceng245er1.ref10">Simpson, et al., 2024</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Patients referred by general practitioners with symptoms suggestive of asthma</p>
|
|
<p>N=118; mean age (SD): 26 (12) years</p>
|
|
<p>UK</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>FEV<sub>1</sub>/FVC</p>
|
|
<p>Cut-offs: <70%, <75%, <LLN,<70% orLLN,<LLN with reduced FEV<sub>1</sub></p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Diagnosis by an expert panel, including at least three asthma clinicians with access to history, physical examination, ACQ, and all test results before and after ICS</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cross-sectional study</p>
|
|
<p>Strata: Adults</p>
|
|
<p>ICS use: 4-week washout</p>
|
|
<p>Smoking status: Mixed (40 (35%) current or ex-smokers)</p>
|
|
<p>Indirectness: Downgraded by one increment due to index test (for thresholds that were not LLN or 70%) indirectness</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Smith 2004 (<a class="bibr" href="#niceng245er1.ref11" rid="niceng245er1.ref11">Smith et al., 2004</a>)</td><td headers="hd_h_niceng245er1.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Consecutive patients aged 8–75 years referred by their family practitioner for asthma diagnosis. Inclusion criteria: people having respiratory symptoms in the preceding 4 weeks. Exclusion criteria: used oral or inhaled corticosteroid in the preceding 4 weeks or had a typical respiratory tract infection in the previous 6 weeks</p>
|
|
<p>N= 47; mean age (range): 35.3 (9–72) years</p>
|
|
<p>New Zealand</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Asthma</td><td headers="hd_h_niceng245er1.tab2_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">For FEV<sub>1</sub> the cut point used to define “abnormal” was 80%. For the FEV<sub>1</sub>/FVC ratio two cut points were used: 80 and 70%.</td><td headers="hd_h_niceng245er1.tab2_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Relevant symptom history (present in all patients), using American Thoracic Society criteria, and a positive test for BHR and/or a positive response to hypertonic saline.</p>
|
|
<p>
|
|
<u>Cut-off</u>
|
|
</p>
|
|
<p>Provocative dose of hypertonic saline resulting in a 15% fall in FEV<sub>1</sub> of less than 20 ml and increase in FEV<sub>1</sub> of ≥12% after receiving albuterol</p>
|
|
</td><td headers="hd_h_niceng245er1.tab2_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>Prospective cross-sectional study</p>
|
|
<p>Strata: Adults</p>
|
|
<p>ICS use: 4-week washout</p>
|
|
<p>Smoking status: Mixed</p>
|
|
<p>Indirectness: Downgraded by two increments due index test (LLN not used as cut-off) and population (mixed children and adolescents/young people) indirectness</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng245er1tab3"><div id="niceng245er1.tab3" class="table"><h3><span class="label">Table 3</span><span class="title">Clinical evidence summary: diagnostic test accuracy for spirometry in adults</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.tab3/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.tab3_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies</th><th id="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N</th><th id="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95%CI)</th><th id="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC ratio (cut-off: 70%) vs clinician diagnosis with hypertonic saline provocation test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.35 (0.14–0.62)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 1.00 (0.88–1.00)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV<sub>1</sub>/FVC ratio (cut-off: <70%) vs expert panel diagnosis with multiple diagnostic tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">118</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.30 (0.20–0.42)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.96 (0.86–0.99)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC ratio (cut-off: 75%) vs clinician diagnosis with bronchodilator reversibility and/or methacholine bronchial challenge test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">303</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.39 (0.32–0.47)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>5</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.83 (0.75–0.89)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV<sub>1</sub>/FVC ratio (cut-off: <75%) vs expert panel diagnosis with multiple diagnostic tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">118</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.49 (0.36–0.61)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>5</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.90 (0.77–0.97)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC (cut-off: 76%) vs diagnosis with bronchodilator reversibility or methacholine bronchial challenge tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">702</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>6</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>7</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.51 (0.46–0.56)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>6</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>7</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.76 (0.71–0.80)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC ratio (cut-off: 78%) vs clinician diagnosis with bronchodilator reversibility and/or methacholine bronchial challenge test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">303</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>8</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity= 0.54 (0.44–0.64)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>8</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity= 0.79 (0.66–0.88)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC (cut-off: 78.79%) vs clinician diagnosis and histamine bronchial provocation test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">283</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>9</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.52 (0.40–0.64)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>9</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>4</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.83 (0.77–0.87)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC ratio (cut-off: 80%) vs clinician diagnosis with hypertonic saline provocation test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">47</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.47 (0.23–0.72)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>5</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.80 (0.61–0.92)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC (cut-off: 84.76%) vs diagnosis with methacholine bronchial challenge test</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">692</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>8</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>7</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.66 (0.59–0.74)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>8</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>7</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.68 (0.63–0.72)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">VERY LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV<sub>1</sub>/FVC ratio (cut-off: <LLN) vs expert panel diagnosis with multiple diagnostic tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">118</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.37 (0.26–0.50)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.96 (0.86–0.99)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV<sub>1</sub>/FVC ratio (cut-off: <70% or LLN) vs expert panel diagnosis with multiple diagnostic tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">118</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.39 (0.27–0.51)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.96 (0.86–0.99)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1 hd_h_niceng245er1.tab3_1_1_1_2 hd_h_niceng245er1.tab3_1_1_1_3 hd_h_niceng245er1.tab3_1_1_1_4 hd_h_niceng245er1.tab3_1_1_1_5 hd_h_niceng245er1.tab3_1_1_1_6 hd_h_niceng245er1.tab3_1_1_1_7 hd_h_niceng245er1.tab3_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV<sub>1</sub>/FVC ratio (cut-off: <LLN with reduced FEV<sub>1</sub>) vs expert panel diagnosis with multiple diagnostic tests</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab3_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">118</td><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.47 (0.35–0.59)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab3_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Very serious<sup>3</sup></td><td headers="hd_h_niceng245er1.tab3_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab3_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.94 (0.83–0.99)</td><td headers="hd_h_niceng245er1.tab3_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng245er1.tab3_1"><p class="no_top_margin">Downgraded by one increment due to concerns arising from the interpretation of the index test and reference standard (unclear if blinded)</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng245er1.tab3_2"><p class="no_top_margin">Downgraded by one increment due to index test (paper did not report standard spirometry was performed to and/or 70% or LLN not used as cut-off) and population (mixed age group: children and young people and adults) indirectness</p></div></dd></dl><dl class="bkr_refwrap"><dt>3</dt><dd><div id="niceng245er1.tab3_3"><p class="no_top_margin">Downgraded by two increments due to concerns arising from the method of participant selection (method not reported) and interpretation of the index test and reference standard (unclear if blinded/unblinded)</p></div></dd></dl><dl class="bkr_refwrap"><dt>4</dt><dd><div id="niceng245er1.tab3_4"><p class="no_top_margin">Downgraded by one increment due to the 95%CI overlapping the threshold corresponding to ‘high specificity’ (80%)</p></div></dd></dl><dl class="bkr_refwrap"><dt>5</dt><dd><div id="niceng245er1.tab3_5"><p class="no_top_margin">Downgraded by two increments due to concerns arising from patient selection (method of selection not</p><p>reported), unclear interpretation of the index test and reference standard (unclear if blinded) and the flow and timing of participants through the study (not all participants were diagnosed with the same reference standard)</p></div></dd></dl><dl class="bkr_refwrap"><dt>6</dt><dd><div id="niceng245er1.tab3_6"><p class="no_top_margin">Downgraded by two increments due to index test (paper did not report standard spirometry was performed to and lower limit of normal not used as cut-off) and reference standard (unclear if clinician decision was involved in diagnosis) indirectness</p></div></dd></dl><dl class="bkr_refwrap"><dt>7</dt><dd><div id="niceng245er1.tab3_7"><p class="no_top_margin">Downgraded by two increments due to concerns arising from the method of participant selection (method not reported), interpretation of the index test and reference standard (unclear if blinded) and the flow and timing of participants through the study (data only reported for training cohort (n=166), not including validation cohort)</p></div></dd></dl><dl class="bkr_refwrap"><dt>8</dt><dd><div id="niceng245er1.tab3_8"><p class="no_top_margin">Downgraded by two increments due to concerns arising from selection bias (recruitment method not reported) and interpretation of the index test and reference standard (unclear if blinded)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er1tab4"><div id="niceng245er1.tab4" class="table"><h3><span class="label">Table 4</span><span class="title">Clinical evidence summary: diagnostic test accuracy for spirometry in children and young people</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.tab4/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.tab4_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er1.tab4_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Studies</th><th id="hd_h_niceng245er1.tab4_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">N</th><th id="hd_h_niceng245er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Risk of bias</th><th id="hd_h_niceng245er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Inconsistency</th><th id="hd_h_niceng245er1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Indirectness</th><th id="hd_h_niceng245er1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Imprecision</th><th id="hd_h_niceng245er1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Effect size (95%CI)</th><th id="hd_h_niceng245er1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quality</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_1 hd_h_niceng245er1.tab4_1_1_1_2 hd_h_niceng245er1.tab4_1_1_1_3 hd_h_niceng245er1.tab4_1_1_1_4 hd_h_niceng245er1.tab4_1_1_1_5 hd_h_niceng245er1.tab4_1_1_1_6 hd_h_niceng245er1.tab4_1_1_1_7 hd_h_niceng245er1.tab4_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">% Predicted FEV1 (cut-off: 88.4%) vs clinician diagnosis with bronchodilator reversibility</td></tr><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">275</td><td headers="hd_h_niceng245er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.68 (0.61–0.75)</td><td headers="hd_h_niceng245er1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>1</sup></td><td headers="hd_h_niceng245er1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.76 (0.66–0.85)</td><td headers="hd_h_niceng245er1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">LOW</td></tr><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_1 hd_h_niceng245er1.tab4_1_1_1_2 hd_h_niceng245er1.tab4_1_1_1_3 hd_h_niceng245er1.tab4_1_1_1_4 hd_h_niceng245er1.tab4_1_1_1_5 hd_h_niceng245er1.tab4_1_1_1_6 hd_h_niceng245er1.tab4_1_1_1_7 hd_h_niceng245er1.tab4_1_1_1_8" colspan="8" rowspan="1" style="text-align:left;vertical-align:top;">FEV1/FVC ratio (cut-off: 85.3%) vs clinician diagnosis with bronchodilator reversibility</td></tr><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_1" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">1 cross-sectional study</td><td headers="hd_h_niceng245er1.tab4_1_1_1_2" rowspan="2" colspan="1" style="text-align:left;vertical-align:top;">275</td><td headers="hd_h_niceng245er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Sensitivity: 0.73 (0.66–0.79)</td><td headers="hd_h_niceng245er1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr><tr><td headers="hd_h_niceng245er1.tab4_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Serious<sup>2</sup></td><td headers="hd_h_niceng245er1.tab4_1_1_1_6" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Not serious</td><td headers="hd_h_niceng245er1.tab4_1_1_1_7" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Specificity: 0.65 (0.54–0.76)</td><td headers="hd_h_niceng245er1.tab4_1_1_1_8" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MODERATE</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt>1</dt><dd><div id="niceng245er1.tab4_1"><p class="no_margin">Downgraded by one increment due to indirectness of the index test (protocol-specified cut-off not used)</p></div></dd></dl><dl class="bkr_refwrap"><dt>2</dt><dd><div id="niceng245er1.tab4_2"><p class="no_margin">Downgraded by one increment due to the confidence interval overlapping the upper threshold for ‘high specificity’ (80%)</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er1tab5"><div id="niceng245er1.tab5" class="table"><h3><span class="label">Table 5</span><span class="title">Spirometry per-test cost</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.tab5/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.tab5_lrgtbl__"><table class="no_bottom_margin"><thead><tr><th id="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Resource</th><th id="hd_h_niceng245er1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Quantity</th><th id="hd_h_niceng245er1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Unit costs</th><th id="hd_h_niceng245er1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Total cost</th><th id="hd_h_niceng245er1.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Source</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">MicroLab with integral printer and spirometry PC software</td><td headers="hd_h_niceng245er1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/2100 <sup>(a)</sup></td><td headers="hd_h_niceng245er1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1,174.13 per spirometer</td><td headers="hd_h_niceng245er1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.62</td><td headers="hd_h_niceng245er1.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS Supply Chain Catalogue(<a class="bibr" href="#niceng245er1.ref9" rid="niceng245er1.ref9">NHS Supply Chain Catalogue., 2022</a>)</td></tr><tr><td headers="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Calibration syringe 3 litre</td><td headers="hd_h_niceng245er1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1/2100 <sup>(a)</sup></td><td headers="hd_h_niceng245er1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£231.69 per syringe</td><td headers="hd_h_niceng245er1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£0.12</td><td headers="hd_h_niceng245er1.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS Supply Chain Catalogue(<a class="bibr" href="#niceng245er1.ref9" rid="niceng245er1.ref9">NHS Supply Chain Catalogue., 2022</a>)</td></tr><tr><td headers="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Bacterial filter plus mouthpiece</td><td headers="hd_h_niceng245er1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">1</td><td headers="hd_h_niceng245er1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.06 per filter and mouthpiece</td><td headers="hd_h_niceng245er1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£1.06</td><td headers="hd_h_niceng245er1.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">NHS Supply Chain Catalogue(<a class="bibr" href="#niceng245er1.ref9" rid="niceng245er1.ref9">NHS Supply Chain Catalogue., 2022</a>)</td></tr><tr><td headers="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Time of practice nurse</td><td headers="hd_h_niceng245er1.tab5_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">20 minutes</td><td headers="hd_h_niceng245er1.tab5_1_1_1_3" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£63.38 per hour</td><td headers="hd_h_niceng245er1.tab5_1_1_1_4" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">£21.13</td><td headers="hd_h_niceng245er1.tab5_1_1_1_5" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">PSSRU 2022(Jones, et al.)</td></tr><tr><td headers="hd_h_niceng245er1.tab5_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<b>Total cost</b>
|
|
</td><td headers="hd_h_niceng245er1.tab5_1_1_1_2 hd_h_niceng245er1.tab5_1_1_1_3 hd_h_niceng245er1.tab5_1_1_1_4 hd_h_niceng245er1.tab5_1_1_1_5" colspan="4" rowspan="1" style="text-align:center;vertical-align:top;">£22.93</td></tr></tbody></table></div><div class="tblwrap-foot"><div><dl class="temp-labeled-list small"><dl class="bkr_refwrap"><dt></dt><dd><div><p class="no_margin">Note: all prices are VAT-exclusive</p></div></dd></dl><dl class="bkr_refwrap"><dt>a)</dt><dd><div id="niceng245er1.tab5_1"><p class="no_margin">Assuming that the equipment would last for 7 years and used on average 2100 times during that period(<a class="bibr" href="#niceng245er1.ref6" rid="niceng245er1.ref6">MicroDirect, 2019</a>). Annuatisation was undertaken assuming a rate of 3.5%.</p></div></dd></dl></dl></div></div></div></article><article data-type="table-wrap" id="figobniceng245er1apphtab1"><div id="niceng245er1.apph.tab1" class="table"><h3><span class="label">Table 9</span><span class="title">Studies excluded from the clinical review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.apph.tab1/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.apph.tab1_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Study</th><th id="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Code [Reason]</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Abramson, M. J., Gwini, S. M., de Klerk, N. H.
|
|
et al (2020) Predictive value of non-specific bronchial challenge testing for respiratory symptoms and lung function in aluminium smelter workers. Occupational & Environmental Medicine
|
|
77(8): 535–539
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32265234" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32265234</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Participants not presenting with symptoms/suspected of asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Almeshari, M. A., Alobaidi, N. Y., Edgar, R. G.
|
|
et al (2020) Physiological tests of small airways function in diagnosing asthma: a systematic review. BMJ open respiratory research
|
|
7(1): 12 [<a href="/pmc/articles/PMC7754643/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7754643</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33371011" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33371011</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Almeshari, M. A.; Stockley, J.; Sapey, E. (2021) The diagnosis of asthma. Can physiological tests of small airways function help?. Chronic Respiratory Disease
|
|
18: 14799731211053332
|
|
[<a href="/pmc/articles/PMC8543738/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8543738</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34693751" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34693751</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- More recent systematic review included that covers the same topic</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Arikoglu, T., Batmaz, S. B., Unlu, A.
|
|
et al (2018) The Diagnostic Value of Impulse Oscillometry and Plethysmography for the Assessment of Exercise-Induced Bronchoconstriction in Asthmatic Children. Pediatric, Allergy, Immunology, and Pulmonology
|
|
31(1): 24–31
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Participants already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Backman, K., Ollikainen, H., Piippo-Savolainen, E.
|
|
et al (2018) Asthma and lung function in adulthood after a viral wheezing episode in early childhood. Clinical & Experimental Allergy
|
|
48(2): 138–146
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29143374" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29143374</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Participants already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Badnjevic, A., Cifrek, M., Koruga, D.
|
|
et al (2015) Neuro-fuzzy classification of asthma and chronic obstructive pulmonary disease. BMC Medical Informatics & Decision Making
|
|
15suppl3: 1
|
|
[<a href="/pmc/articles/PMC4705495/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4705495</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/26391218" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26391218</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Participants already diagnosed with asthma or COPD</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Benjelloun, H., Zaidane, S., Zaghba, N.
|
|
et al (2019) Clinical, functional and therapeutic features of asthma in the elderly. Revue Francaise d'Allergologie
|
|
59(2): 58–62
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Study not reported in English</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bokov, P., Martin, C., Graba, S.
|
|
et al (2017) Bronchodilator Response Assessment of the Small Airways Obstructive Pattern. The Open Respiratory Medicine Journal
|
|
11: 47–53
|
|
[<a href="/pmc/articles/PMC5543622/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5543622</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/28839497" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28839497</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>impulse oscillometry</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Borak, J. and Lefkowitz, R. Y. (2016) Bronchial hyperresponsiveness. Occupational Medicine (Oxford)
|
|
66(2): 95–105 [<a href="https://pubmed.ncbi.nlm.nih.gov/26590957" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 26590957</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Borak, J.; Lefkowitz, R. Y.; Linde, B. (2018) Bronchial hyper-responsiveness: a technical update. Occupational Medicine (Oxford)
|
|
68(8): 519–522 [<a href="https://pubmed.ncbi.nlm.nih.gov/30192977" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30192977</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Bougard, N., Nekoee, H., Schleich, F.
|
|
et al (2020) Assessment of diagnostic accuracy of lung function indices and FeNO for a positive methacholine challenge. Biochemical Pharmacology
|
|
179: 113981
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32305435" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32305435</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Patients already receiving ICS with no washout prior to tests</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chaiwong, W., Namwongprom, S., Liwsrisakun, C.
|
|
et al (2022) The roles of impulse oscillometry in detection of poorly controlled asthma in adults with normal spirometry. Journal of Asthma
|
|
59(3): 561–571 [<a href="https://pubmed.ncbi.nlm.nih.gov/33356696" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33356696</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Chawes, B. and Elenius, V. (2022) Pulmonary function testing for the diagnosis of asthma in preschool children. Current Opinion in Allergy & Clinical Immunology
|
|
22(2): 101–106
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/35197431" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35197431</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Pre-school children (protocol specified >5 years old)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
de Jong, C. C. M., Pedersen, E. S. L., Mozun, R.
|
|
et al (2019) Diagnosis of asthma in children: the contribution of a detailed history and test results. European Respiratory Journal
|
|
54(6): 12 [<a href="https://pubmed.ncbi.nlm.nih.gov/31515409" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31515409</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>ICS washout period not suitable (24h, protocol specified at least 4 weeks)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dean, B. W., Birnie, E. E., Whitmore, G. A.
|
|
et al (2018) Between-Visit Variability in FEV1 as a Diagnostic Test for Asthma in Adults. Annals of the American Thoracic Society
|
|
15(9): 1039–1046
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/29877740" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29877740</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Dos Santos, K., Fausto, L. L., Camargos, P. A. M.
|
|
et al (2017) Impulse oscillometry in the assessment of asthmatic children and adolescents: from a narrative to a systematic review. Paediatric Respiratory Reviews
|
|
23: 61–67
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/27825614" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27825614</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Systematic review of cohort studies including participants with pre-study diagnosis</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Elenius, V., Chawes, B., Malmberg, P. L.
|
|
et al (2021) Lung function testing and inflammation markers for wheezing preschool children: A systematic review for the EAACI Clinical Practice Recommendations on Diagnostics of Preschool Wheeze. Pediatric Allergy & Immunology
|
|
32(3): 501–513
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/33222297" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33222297</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Pre-school children (protocol specified >5 years old)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Francisco, B., Ner, Z., Ge, B.
|
|
et al (2015) Sensitivity of different spirometric tests for detecting airway obstruction in childhood asthma. Journal of Asthma
|
|
52(5): 505–11 [<a href="https://pubmed.ncbi.nlm.nih.gov/25375906" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25375906</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gaillard, E. A., Kuehni, C. E., Turner, S.
|
|
et al (2021) European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years. European Respiratory Journal
|
|
58(5): 10 [<a href="https://pubmed.ncbi.nlm.nih.gov/33863747" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33863747</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Grzelewski, T., Witkowski, K., Makandjou-Ola, E.
|
|
et al (2014) Diagnostic value of lung function parameters and FeNO for asthma in schoolchildren in large, real-life population. Pediatric Pulmonology
|
|
49(7): 632–40
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/24019244" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 24019244</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Aiming to diagnose a condition not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Aiming to diagnose allergic asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Gurbeta, L., Badnjevic, A., Maksimovic, M.
|
|
et al (2018) A telehealth system for automated diagnosis of asthma and chronical obstructive pulmonary disease. Journal of the American Medical Informatics Association
|
|
25(9): 1213–1217
|
|
[<a href="/pmc/articles/PMC7646878/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7646878</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/29788482" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 29788482</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Patients in primary care - not presenting with respiratory complaints</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Heijkenskjold Rentzhog, C., Janson, C., Berglund, L.
|
|
et al (2017) Overall and peripheral lung function assessment by spirometry and forced oscillation technique in relation to asthma diagnosis and control. Clinical & Experimental Allergy
|
|
47(12): 1546–1554
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28940832" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28940832</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study does not contain an intervention relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hou, L., Hao, H., Huang, G.
|
|
et al (2021) The value of small airway function parameters and fractional exhaled nitric oxide for predicting positive methacholine challenge test in asthmatics of different ages with FEV1 >= 80% predicted. Clinical and Translational Allergy
|
|
11(1) [<a href="/pmc/articles/PMC8099229/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8099229</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33900045" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33900045</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Reference standard in study does not match that specified in protocol</p>
|
|
<p>
|
|
<i>Objective test used as reference standard without clinical diagnosis</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Hunter, C. J., Brightling, C. E., Woltmann, G.
|
|
et al (2002) A comparison of the validity of different diagnostic tests in adults with asthma. Chest
|
|
121(4): 1051–7
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/11948032" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 11948032</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma and healthy controls with no symptoms</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Jankrift, N., Kellerer, C., Magnussen, H.
|
|
et al (2021) The role of clinical signs and spirometry in the diagnosis of obstructive airway diseases: a systematic analysis adapted to general practice settings. Journal of Thoracic Disease
|
|
13(6): 3369–3382
|
|
[<a href="/pmc/articles/PMC8264721/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8264721</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/34277033" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34277033</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>No reference standard</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kilci, F., Uyan, Z. S., Celakil, M. E.
|
|
et al (2021) Respiratory function in children with nephrotic syndrome: Comparative evaluation of impulse oscillometry and spirometry. Pediatric Pulmonology
|
|
56(10): 3301–3309
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/34289254" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34289254</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Full text paper not available</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Knihtila, H., Kotaniemi-Syrjanen, A., Pelkonen, A. S.
|
|
et al (2017) Sensitivity of newly defined impulse oscillometry indices in preschool children. Pediatric Pulmonology
|
|
52(5): 598–605
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/27736034" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27736034</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Pre-school children (protocol specified >5 years old)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Koruga, D., Baletic, N., Veres, K. T.
|
|
et al (2018) Impulse oscillometry in evaluation bronchial hyperresponsiveness in patients with persistent allergic rhinitis. Vojnosanitetski Pregled
|
|
75(1): 39–45
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>Impulse oscillometry used as index test</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Kumar, R. and Gupta, N. (2017) Exhaled nitric oxide atopy, and spirometry in asthma and rhinitis patients in India. Advances in Respiratory Medicine
|
|
85(4): 186–192
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/28871585" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 28871585</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Lambert, A., Drummond, M. B., Wei, C.
|
|
et al (2015) Diagnostic accuracy of FEV1/forced vital capacity ratio z scores in asthmatic patients. Journal of Allergy & Clinical Immunology
|
|
136(3): 649–653.e4
|
|
[<a href="/pmc/articles/PMC4562860/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC4562860</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/25863976" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 25863976</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Levy, M. L. (2016) Is spirometry essential in diagnosing asthma? No. British Journal of General Practice
|
|
66(650): 485 [<a href="/pmc/articles/PMC5198706/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5198706</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27563137" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27563137</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Opinion piece</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Li, H., Zhang, X., Zhao, Q.
|
|
et al (2022) Assessment of Clinical Diagnostic Efficacy of Pulmonary Function Test Based on DBN-SVM of Pediatric Asthma and Cough Variant Asthma. Computational Intelligence & Neuroscience
|
|
2022: 1182114
|
|
[<a href="/pmc/articles/PMC8989593/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8989593</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35401730" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35401730</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Louis, R., Satia, I., Ojanguren, I.
|
|
et al (2022) European Respiratory Society Guidelines for the Diagnosis of Asthma in Adults. European Respiratory Journal
|
|
15: 15 [<a href="https://pubmed.ncbi.nlm.nih.gov/35169025" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35169025</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Systematic review used as source of primary studies</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Metting, E. I., In 't Veen, J. C., Dekhuijzen, P. N.
|
|
et al (2016) Development of a diagnostic decision tree for obstructive pulmonary diseases based on real-life data. Erj Open Research
|
|
2(1) [<a href="/pmc/articles/PMC5005160/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC5005160</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/27730177" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 27730177</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Prognostic study</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Miyoshi, S., Katayama, H., Matsubara, M.
|
|
et al (2020) Prediction of Spirometric Indices Using Forced Oscillometric Indices in Patients with Asthma, COPD, and Interstitial Lung Disease. International Journal of Copd
|
|
15: 1565–1575
|
|
[<a href="/pmc/articles/PMC7335892/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC7335892</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/32669842" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32669842</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma, COPD or ILD</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mondal, P., Yirinec, A., Midya, V.
|
|
et al (2019) Diagnostic value of spirometry vs impulse oscillometry: A comparative study in children with sickle cell disease. Pediatric Pulmonology
|
|
54(9): 1422–1430
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/31211524" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 31211524</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Data not reported in an extractable format or a format that can be analysed</p>
|
|
<p>
|
|
<i>Sensitivity, specificity and 2×2 data not reported</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Mousa, H. and Kamal, E. (2018) Impulse oscillation system versus spirometry in assessment of obstructive airway diseases. Egyptian Journal of Chest Diseases and Tuberculosis
|
|
67(2): 106–112
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma or COPD</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Nawaz, S. F.; Ravindrarn, M.; Kuruvilla, M. E. (2022) Asthma diagnosis using patient-reported outcome measures and objective diagnostic tests: now and into the future. Current Opinion in Pulmonary Medicine
|
|
28(3): 251–257
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/35256554" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35256554</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">- Review article but not a systematic review</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Parkes, E. D., Moore, V. C., Walters, G. I.
|
|
et al (2020) Diagnosis of occupational asthma from serial measurements of forced expiratory volume in 1 s (FEV1) using the Area Between Curves (ABC) score from the Oasys plotter. Occupational & Environmental Medicine
|
|
77(11): 801–805
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/32764105" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 32764105</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Peled, M., Ovadya, D., Cohn, J.
|
|
et al (2021) Baseline spirometry parameters as predictors of airway hyperreactivity in adults with suspected asthma. BMC Pulmonary Medicine
|
|
21(1): 153
|
|
[<a href="/pmc/articles/PMC8101108/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8101108</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/33957916" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33957916</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>Spirometry carried out, but no index tests relevant to the protocol reported</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Popović-Grle, S., Mehulić, M., Pavicić, F.
|
|
et al (2002) Clinical validation of bronchial hyperresponsiveness, allergy tests and lung function in the diagnosis of asthma in persons with dyspnea. Coll Antropol
|
|
26suppl: 119–27 [<a href="https://pubmed.ncbi.nlm.nih.gov/12674843" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 12674843</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>Study reports FEV1, but not FEV1/FVC ratio</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Qin, R., An, J., Xie, J.
|
|
et al (2021) FEF25–75% Is a More Sensitive Measure Reflecting Airway Dysfunction in Patients with Asthma: A Comparison Study Using FEF25–75% and FEV1. The Journal of Allergy & Clinical Immunology in Practice
|
|
9(10): 3649–3659.e6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/34214706" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 34214706</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Raji, H., Haddadzadeh Shoushtari, M., Idani, E.
|
|
et al (2018) Forced Expiratory Flow at 25–75% as a Marker for Airway Hyper Responsiveness in Adult Patients with Asthma-like Symptoms. Tanaffus
|
|
17(2): 90–95 [<a href="/pmc/articles/PMC6320556/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC6320556</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/30627179" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 30627179</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>Spirometry carried out, but no index test relevant to the protocol reported</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Schneider, A., Gindner, L., Tilemann, L.
|
|
et al (2009) Diagnostic accuracy of spirometry in primary care. BMC Pulm Med
|
|
9: 31
|
|
[<a href="/pmc/articles/PMC2714498/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC2714498</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/19591673" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19591673</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>ICS washout period not appropriate (12h, protocol specified >4 weeks)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Shafiq, I., Uzbeck, M. H., Zoumot, Z.
|
|
et al (2021) Correlation between Reduced FEF25–75% and a Positive Methacholine Challenge Test in Adults with Nonobstructive Baseline Spirometry. Pulmonary Medicine
|
|
2021: 6959322
|
|
[<a href="/pmc/articles/PMC8731260/" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pmc">PMC free article<span class="bk_prnt">: PMC8731260</span></a>] [<a href="https://pubmed.ncbi.nlm.nih.gov/35003806" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 35003806</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Data not reported in an extractable format or a format that can be analysed</p>
|
|
<p>
|
|
<i>Diagnostic accuracy data only given in ROC curves</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Sivan, Y., Gadish, T., Fireman, E.
|
|
et al (2009) The use of exhaled nitric oxide in the diagnosis of asthma in school children. J Pediatr
|
|
155(2): 211–6
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/19394049" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 19394049</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Study design not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Reference standard completed 18 months after index test (protocol specified 12 months or less)</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Stanbrook, M. B.; Chapman, K. R.; Kesten, S. (1995) Gas trapping as a predictor of positive methacholine challenge in patients with normal spirometry results. Chest
|
|
107(4): 992–5
|
|
[<a href="https://pubmed.ncbi.nlm.nih.gov/7705166" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 7705166</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Index test in study does not match that specified in the protocol</p>
|
|
<p>
|
|
<i>No protocol index tests used in study</i>
|
|
</p>
|
|
</td></tr><tr><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
Zhang, Y., Shi, H., Su, A.
|
|
et al (2022) Angle beta combined with FeNO and FEV1/FVC% for the detection of asthma in school-aged children. Journal of Asthma
|
|
59(4): 746–754 [<a href="https://pubmed.ncbi.nlm.nih.gov/33435766" ref="pagearea=body&targetsite=entrez&targetcat=link&targettype=pubmed">PubMed<span class="bk_prnt">: 33435766</span></a>]
|
|
</td><td headers="hd_h_niceng245er1.apph.tab1_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">
|
|
<p>- Population not relevant to this review protocol</p>
|
|
<p>
|
|
<i>Already diagnosed with asthma</i>
|
|
</p>
|
|
</td></tr></tbody></table></div></div></article><article data-type="table-wrap" id="figobniceng245er1apphtab2"><div id="niceng245er1.apph.tab2" class="table"><h3><span class="label">Table 10</span><span class="title">Studies excluded from the health economic review</span></h3><p class="large-table-link" style="display:none"><span class="right"><a href="/books/NBK612145/table/niceng245er1.apph.tab2/?report=objectonly" target="object">View in own window</a></span></p><div class="large_tbl" id="__niceng245er1.apph.tab2_lrgtbl__"><table><thead><tr><th id="hd_h_niceng245er1.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reference</th><th id="hd_h_niceng245er1.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">Reason for exclusion</th></tr></thead><tbody><tr><td headers="hd_h_niceng245er1.apph.tab2_1_1_1_1" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;">None</td><td headers="hd_h_niceng245er1.apph.tab2_1_1_1_2" rowspan="1" colspan="1" style="text-align:left;vertical-align:top;"></td></tr></tbody></table></div></div></article></div><div id="jr-scripts"><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/libs.min.js"> </script><script src="/corehtml/pmc/jatsreader/ptpmc_3.22/js/jr.min.js"> </script></div></div>
|
|
|
|
|
|
|
|
|
|
<!-- Book content -->
|
|
|
|
<script type="text/javascript" src="/portal/portal3rc.fcgi/rlib/js/InstrumentNCBIBaseJS/InstrumentPageStarterJS.js"> </script>
|
|
|
|
|
|
<!-- CE8B5AF87C7FFCB1_0191SID /projects/books/PBooks@9.11 portal105 v4.1.r689238 Tue, Oct 22 2024 16:10:51 -->
|
|
<span id="portal-csrf-token" style="display:none" data-token="CE8B5AF87C7FFCB1_0191SID"></span>
|
|
|
|
<script type="text/javascript" src="//static.pubmed.gov/portal/portal3rc.fcgi/4216699/js/3968615.js" snapshot="books"></script></body>
|
|
</html>
|