The new BTS/SIGN asthma guidelines (2016)1 have given some clear and pragmatic guidance on diagnosing and managing asthma. The aim of this article is to reflect on the information in these guidelines and to offer a personal view of how to implement them in practice.
So what do they say? The section on diagnosis reiterates the importance of history taking and stresses the fact that the diagnosis is a clinical one based on the patient’s history. This is important as it reminds us that the tests which might be used to confirm the diagnosis are the icing on the diagnostic cake – they are not the cake itself.
Symptoms such as cough, dyspnoea, tight chest and, most significantly, any history of wheeze are important elements of making the diagnosis. Wheeze which has been heard by a clinician is highly relevant and any audible wheeze should be recorded, ensuring that it is an expiratory wheeze and not inspiratory stridor, which will affect the differential diagnosis.