Why we are targeting a better way to diagnose and treat asthma – Dr Stephen Fowler

On World Asthma Day, Dr Stephen Fowler, Honorary Consultant in Respiratory Medicine at Wythenshawe Hospital, and NIHR Manchester Biomedical Research Centre (BRC) Asthma Programme Associate Lead, reflects on the current routes to asthma diagnosis, the implications of misdiagnosis and how he hopes our current research will lead to improvements in care by getting each patient on the right treatment at the right time.

STOP

The theme of this year’s World Asthma Day is STOP:

• Symptom evaluation
• Test response
• Observe and assess
• Proceed to adjust treatment

Diagnosing asthma can be challenging

Although asthma is an extremely common condition, diagnosing asthma can be challenging as there currently isn’t one definitive test available. Getting an accurate diagnosis of asthma is really important – it is often a lifelong condition, and receiving the wrong diagnosis and treatment can have life-changing consequences. In Manchester we are conducting a study to try and help work out the best way of diagnosing asthma in order to ensure patients get the treatment they need as early as possible.

We have asked GPs to send anyone they think might have asthma to the National Institute for Health Research (NIHR) Manchester Clinical Research Facility (CRF) at Wythenshawe Hospital – a dedicated, purpose-built space and a safe, quality assured environment for delivering clinical research studies. Patients who attend the CRF will have their symptoms assessed by a respiratory doctor, and (as long as we don’t think they have any other serious problem that needs urgent treatment) will undergo a serious of tests over two or three visits. These tests include those recommended by the UK national bodies that have produced asthma guidelines (the British Thoracic Society/Scottish Intercollegiate Guideline Network, and the National Institute for Health and Care Excellence), and when we get the results we hope to be able to recommend which tests will be most useful in diagnosing asthma.

We will also see if some new tests can be used to detect and guide treatment in asthma. Whilst these tests are technically very advanced, they are also completely non-invasive and easy for patients to perform. They include a test that measures chemicals in the breath, that may give us clues about what sort of problem is affecting the lungs. Other tests measure the size of the airways (breathing tubes) deep down in the lungs – these airways are often affected first in asthma, and we think that assessing them will be really important for future asthma care and treatment.

Getting each patient on the right treatment at the right time

Our study doesn’t stop at getting a correct diagnosis. We will also be prescribing patients’ carefully monitored treatment for two months, and bring them back to see how they have responded. We’ll be using the most commonly used treatment for asthma – inhaled steroids – and with our detailed assessment will aim to find ways of predicting who will and won’t respond to this treatment. We hope in the next few years this will lead to improvements in care, by getting each patient on the right treatment at the right time.

The World Asthma Day theme of STOP encourages us all to think hard about what is important to people with asthma, and we at Manchester BRC and CRF hope to be able to help by testing different strategies for diagnosis and recommending one that is achievable and useful.