There is a need to improve asthma identification and access to treatment to improve quality of life for patients. Diagnosis is difficult as there is no single diagnostic test, but it should be in line with BTS/Sign guidelines. NHS England’s National Bundle of Care for children and young people with asthma sets out a series of standards to help integrated care systems (ICSs) improve health outcomes for all children and young people with asthma. There is a section on early and accurate diagnosis with national standards of care.

A useful quick reference guide to diagnosis and management: British guideline on the management of asthma.

Spirometry is recommended for adults, but may be less useful in children. NICE guidance suggests its use as well as Fractional exhaled Nitric Oxide (FeNO).  Diagnostic hubs should ensure access to spirometry and FeNO appliances that are suitable for use in CYP and ensure people are trained to conduct these physiological tests in CYP.

More information on the ARTP Spirometry register and some FAQs.

The Scottish Intercollegiate Guidelines Network (SIGN) have produced a diagnostic algorithm . An asthma diagnosis, monitoring and chronic asthma management guideline is being developed jointly by NICE, SIGN and the British Thoracic Society (BTS) and is expected in July 2024.

Diagnosis should include the following:

• Detailed relevant family and personal medical history recorded in notes.
• Two weeks of peak flows. Objective measurement of lung function is important in the diagnosis and assessment of acute and chronic asthma. This guide on peak flow measurement will provide support to clinicians.
• Document variable airflow obstruction.
• Document response to trial of therapy.
• Document findings during attacks/flare ups: (Peak flow pre and post treatment with bronchodilators), Oxygen Saturations, features of severity as per the BTS /SIGN Guidelines.
• Diagnosis in child able to record peak flow.
• Diagnosis in child too young to record peak flow.

Ensure clinicians have a good understanding of best practice and consider regular audits of practice using the BTS, SIGN and NICE guideline, the London asthma standards for children and young people and the NICE Asthma Quality Standard QS25 and have received training in asthma diagnosis and management.