Last reviewed: 20 Sep 2020
Last updated: 14 Jul 2020

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • recent upper respiratory tract infection
  • dyspnoea
  • cough
  • expiratory wheezes
  • nasal polyposis

Risk factors

  • family history
  • allergens
  • atopic history
  • nasal polyposis
  • obesity
  • gastro-oesophageal reflux
  • obstructive sleep apnoea

Diagnostic investigations

1st investigations to order

  • FEV₁/FVC ratio
  • peak expiratory flow rate (PEFR)
  • CXR
  • FBC
More 1st investigations to order

Investigations to consider

  • bronchial challenge test
  • immunoassay for allergen-specific IgE
  • skin prick allergy testing
More investigations to consider

Emerging tests

  • fractional exhaled nitric oxide (FeNO)
  • sputum eosinophilia
More emerging tests

Treatment algorithm

Contributors

Fellow

Division of Pulmonary and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

LE declares that she has no competing interests.

Clinical Assistant Professor (Affiliated)

Division of Pulmonary and Critical Care Medicine

Department of Medicine

Stanford University School of Medicine

Stanford

CA

Disclosures

SM declares that he has no competing interests.

Dr Lauren Eggert and Dr Sourav Majumdar would like to gratefully acknowledge Dr Irwani Ibrahim, Dr Kay Choong See, Dr Francis Thien, and Dr Catherine Weiler, previous contributors to this topic.

Peer reviewersVIEW ALL

Clinical Director

Division of Allergy and Inflammation

Beth Israel Deaconess Medical Center/Harvard Medical School

Boston

MA

Disclosures

JS is a consultant for Aventis, GSK, and Novartis/Genentech; is on the Speakers Bureau for Merck, Aventis, GSK, AstraZeneca, Pfizer, Novartis/Genentech, Inspire, and UCB; has had research sponsored by GSK; is an expert witness at Haemonetics; and has received publication honorarium at Emedicine.

Research Manager

Imperial College Healthcare Trust

NHLI Airways Division

Imperial College London (Honorary) Respiratory Research

Chest & Allergy

St Mary's Hospital

London

UK

Disclosures

SMSS declares that she has no competing interests.

Professor of Respiratory Medicine

Respiratory Medicine Section

Division of Immunology, Infection & Inflammation

University of Glasgow

Glasgow

UK

Disclosures

NT declares that he has no competing interests.

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