The use of a direct bronchial challenge test in primary care to diagnose asthma

NPJ Prim Care Respir Med. 2020 Oct 16;30(1):45. doi: 10.1038/s41533-020-00202-y.

Abstract

Many asthmatics in primary care have mild symptoms and lack airflow obstruction. If variable expiratory airflow limitation cannot be determined by spirometry or peak expiratory flow, despite a history of respiratory symptoms, a positive bronchial challenge test (BCT) can confirm the diagnosis of asthma. However, BCT is traditionally performed in secondary care. In this observational real-life study, we retrospectively analyze 5-year data of a primary care diagnostic center carrying out BCT by histamine provocation. In total, 998 primary care patients aged ≥16 years underwent BCT, without any adverse events reported. To explore diagnostic accuracy, we examine 584 patients with a high pretest probability of asthma. Fifty-seven percent of these patients have a positive BCT result and can be accurately diagnosed with asthma. Our real-life data show BCT is safe and feasible in a suitably equipped primary care diagnostic center. Furthermore, it could potentially reduce diagnostic referrals to secondary care.

Publication types

  • Observational Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Asthma / diagnosis*
  • Bronchial Provocation Tests* / adverse effects
  • Bronchial Provocation Tests* / methods
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care / methods*
  • Reproducibility of Results
  • Retrospective Studies
  • Young Adult