title: The level of diagnostic assessment in severe asthma: A nationwide real-life study.
abstract: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.
  
  
  
  To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.
  
  
  
  A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.
  
  
  
  Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.
  
  
  
  Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 66, 2400 Copenhagen NV, Denmark. Electronic address: annavonbulow@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: von Bülow
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 66, 2400 Copenhagen NV, Denmark.
authors.forename: Vibeke
authors.initials: V
authors.lastname: Backer
authors.affiliation: Department of Respiratory and Internal Medicine, Naestved Hospital, Denmark; Institute for Regional Health Research, University of Southern Denmark, Denmark; Department of Respiratory and Internal Medicine, Roskilde Hospital, Denmark.
authors.forename: Uffe
authors.initials: U
authors.lastname: Bodtger
authors.affiliation: Department of Respiratory and Internal Medicine, Roskilde Hospital, Denmark.
authors.forename: Niels Ulrik
authors.initials: NU
authors.lastname: Søes-Petersen
authors.affiliation: Department of Respiratory Medicine, Aalborg University Hospital, Denmark.
authors.forename: Karin Dahl
authors.initials: KD
authors.lastname: Assing
authors.affiliation: Department of Respiratory Medicine, Aarhus University Hospital, Denmark.
authors.forename: Tina
authors.initials: T
authors.lastname: Skjold
authors.affiliation: Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 66, 2400 Copenhagen NV, Denmark.
authors.forename: Celeste
authors.initials: C
authors.lastname: Porsbjerg
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D001249:Asthma / Q000097:blood / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology*; D001985:Bronchial Provocation Tests / Q000379:methods; D003430:Cross-Sectional Studies; D003718:Denmark / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D012129:Respiratory Function Tests / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D012907:Smoking / Q000009:adverse effects / Q000453:epidemiology; D055815:Young Adult
keywords: Asthma; Asthma assessment; Asthma diagnosis; Asthma management; Difficult to treat asthma; Severe asthma