title: The challenge of objective confirmation of asthma diagnosis in primary care.
abstract: Asthma represents one of the most common chronic conditions encountered in primary care and diagnosis should be confirmed objectively with the demonstration of variable airflow obstruction. As many asthmatics have normal lung function at the time of clinical presentation, objective confirmation of airflow limitation may be challenging. Fluctuations in airflow obstruction can be documented with simple office spirometry after bronchodilator challenge, home monitoring of peak expiratory flow and bronchoconstriction induced by spasmogens such as methacholine. We present a case highlighting the challenge of objective confirmation of asthma diagnosis in primary care and provide a critical review of the diagnostic approaches highlighted above. Our aim is to provide a pragmatic interpretation of the available literature with a view to assisting clinicians in selecting the diagnostic test best suited for individualised patient encounters.
authors: Michael G Degroote School of Medicine, McMaster University, Hamilton, Ontario, Canada.
authors: Jatin
authors: J
authors: Kaicker
authors: University of Ottawa's School of Medicine, Ottawa, Ontario, Canada.
authors: Wilfred
authors: W
authors: Dang
authors: 1] Primary Care Respiratory Alliance of Canada (PCRC), Toronto, Ontario, Canada [2] Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada.
authors: Anthony
authors: A
authors: D'Urzo
mesh_terms: D001249:Asthma / Q000175:diagnosis*; D003948:Diagnostic Techniques, Respiratory System / Q000592:standards*; D005260:Female; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care