Abstract：
Diagnosing asthma in children represents an important clinical challenge. There is no single gold-standard test to confirm the diagnosis. Consequently, over- and under-diagnosis of asthma is frequent in children.
A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
A task force supported by the European Respiratory Society has developed these evidence-based clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years using nine Population, Intervention, Comparator and Outcome (PICO) questions. The task force conducted systematic literature searches for all PICO questions and screened the outputs from these, including relevant full-text articles. All task force members approved the final decision for inclusion of research papers. The task force assessed the quality of the evidence using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach.
The task force then developed a diagnostic algorithm based on the critical appraisal of the PICO questions, preferences expressed by lay members and test availability. Proposed cut-offs were determined based on the best available evidence. The task force formulated recommendations using the GRADE Evidence to Decision framework.
Based on the critical appraisal of the evidence and the Evidence to Decision framework, the task force recommends spirometry, bronchodilator reversibility testing and exhaled nitric oxide fraction as first-line diagnostic tests in children under investigation for asthma. The task force recommends against diagnosing asthma in children based on clinical history alone or following a single abnormal objective test. Finally, this guideline also proposes a set of research priorities to improve asthma diagnosis in children in the future.
摘要：
儿童哮喘的诊断是一项重要的临床挑战。没有单一的金标准测试来确认诊断。因此,儿童哮喘的过度诊断和诊断不足很常见.
由欧洲呼吸学会支持的一个特别工作组开发了这些基于证据的临床实践指南，用于5-16岁儿童的哮喘诊断，使用9个人口，干预,比较器和结果（PICO）问题。专责小组对所有PICO问题进行了系统的文献检索，并从中筛选出这些问题的输出，包括相关的全文文章。所有工作队成员都批准了纳入研究论文的最终决定。专责小组使用建议分级评估证据的质量，评估,开发和评估(等级)方法。
然后，工作组根据对PICO问题的批判性评估开发了一种诊断算法，由非专业成员表达的偏好和测试可用性。拟议的截止日期是根据现有的最佳证据确定的。工作队使用“决定等级证据”框架提出了建议。
基于对证据和决策证据框架的批判性评估，工作队建议肺活量测定,支气管扩张剂可逆性测试和呼出一氧化氮分数作为哮喘研究儿童的一线诊断测试。工作组建议不要仅根据临床病史或在单个异常客观测试后诊断儿童哮喘。最后,该指南还提出了一系列研究重点，以改善未来儿童哮喘的诊断。
由欧洲呼吸学会支持的一个特别工作组开发了这些基于证据的临床实践指南，用于5-16岁儿童的哮喘诊断，使用9个人口，干预,比较器和结果（PICO）问题。专责小组对所有PICO问题进行了系统的文献检索，并从中筛选出这些问题的输出，包括相关的全文文章。所有工作队成员都批准了纳入研究论文的最终决定。专责小组使用建议分级评估证据的质量，评估,开发和评估(等级)方法。
然后，工作组根据对PICO问题的批判性评估开发了一种诊断算法，由非专业成员表达的偏好和测试可用性。拟议的截止日期是根据现有的最佳证据确定的。工作队使用“决定等级证据”框架提出了建议。
基于对证据和决策证据框架的批判性评估，工作队建议肺活量测定,支气管扩张剂可逆性测试和呼出一氧化氮分数作为哮喘研究儿童的一线诊断测试。工作组建议不要仅根据临床病史或在单个异常客观测试后诊断儿童哮喘。最后,该指南还提出了一系列研究重点，以改善未来儿童哮喘的诊断。
