title: Diagnostic work-up in patients with possible asthma referred to a university hospital.
abstract: OBJECTIVE
  The best strategy for diagnosing asthma remains unclear. Accordingly, the aim of this study was to evaluate diagnostic strategies in individuals with possible asthma referred to a respiratory outpatient clinic at a university hospital.
  
  
  METHODS
  All individuals with symptoms suggestive of asthma referred over 12 months underwent spirometry, bronchodilator reversibility test, Peak expiratory flow rate (PEF) registration, and bronchial challenge test with methacholine and mannitol on three separate days. The results of these tests were compared against an asthma diagnosis based on symptoms, presence of atopy and baseline spirometry made by a panel of three independent respiratory specialists.
  
  
  RESULTS
  Of the 190 individuals examined, 63% (n=122) were classified as having asthma. Reversibility to β2-agonist had the lowest sensitivity of 13%, whereas airway hyperresponsiveness to methacholine had the highest (69%). In contrast, specificity was the highest for reversibility testing (93%), whereas methacholine had the lowest specificity (57%). The combination of reversibility, peak-flow variability, and methacholine yielded a cumulative sensitivity of 78%, albeit a specificity of 41%. In comparison, a combination of reversibility and mannitol resulted in a specificity of 82% and a sensitivity of 42%.
  
  
  CONCLUSIONS
  In this real-life population, different diagnostic test combinations were required to achieve a high specificity for diagnosing asthma and a high sensitivity, respectively: Our findings suggest that the diagnostic test approach should be based on whether the aim is to exclude asthma (high sensitivity required) or confirm a diagnosis of asthma (high specificity required).
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Asger
authors.initials: A
authors.lastname: Sverrild
authors.affiliation: Department of Pulmonary Medicine, Hvidovre University Hospital, Copenhagen, Denmark.
authors.forename: Charlotte Suppli
authors.initials: CS
authors.lastname: Ulrik
authors.affiliation: Department of Respiratory Medicine, Næstved Hospital, Næstved, Denmark.
authors.forename: Uffe
authors.initials: U
authors.lastname: Bødtger
authors.affiliation: Department of Respiratory Medicine Y, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Niels
authors.initials: N
authors.lastname: Seersholm
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Celeste
authors.initials: C
authors.lastname: Porsbjerg
keywords: Asthma management; airway hyperresponsiveness; diagnostic tools; reversibility; sensitivity; specificity; spirometry