More robust diagnostic strategy for asthma needed

A more robust diagnostic strategy for confirming asthma in patients would be valuable for clinicians, the recent Irish Thoracic Society (ITS) 2025 Annual Scientific Meeting heard.

Dr Cara Gill, a respiratory Specialist Registrar and research Fellow at Beaumont Hospital, Dublin, presented a talk titled ‘Asthma untangled: Standardising expert clinician judgement with a structured multi-modal approach’.

Dr Gill and colleagues recently completed a prospective cohort study, with the primary objective of demonstrating the efficacy of the AZTEC score.

She explained that the study aimed to answer the question: “Do patients in clinic actually have asthma to begin with?”

“The first question we had to ask is how do we actually decide what was asthma and what wasn’t asthma,” she said.

Dr Gill added that a cohort of patients referred from primary care, or other clinics in the hospital, had symptoms suggestive of asthma or the label of asthma.

“They were already on inhaled corticosteroid therapy and they remained symptomatic,” she said.

“We know that the guidelines don’t really tell us what to do with these patients to confirm that they have asthma,” she said.

The team assigned a score to features that suggested that patients had asthma or another condition. Patients attended the clinic five times over six months, and investigations, including questionnaires and home FEV1 (forced expiratory volume in one second) monitors, were performed.

“After the end of that [period], we were able to provide a template that assigned up to 16 features that suggested someone had asthma or did not have asthma,” she said.

A total of 222 people completed the study, with asthma confirmed in 60 per cent of participants. Among the 40 per cent who did not have asthma, other conditions included allergic rhinitis, gastro-oesophageal reflux disease, and chronic obstructive pulmonary disease (COPD).

She said that the study highlighted the need for a more robust diagnostic strategy in confirming asthma.

The ITS meeting also heard from Prof Breda Cushen, HSE National Respiratory Clinical Lead, who delivered a guest lecture on the changing face of COPD care in Ireland.

Prof Cushen said that clinical outcomes are better when comprehensive multidimensional approaches are used to inform clinical decision-making in complex conditions like COPD.

Although she admitted there were regional disparities, Prof Cushen said Ireland has taken a “visionary approach” to COPD care.