Avoid initiating regular asthma medication in adults without confirmed variable airflow obstruction (e.g., via spirometry, positive provocation test, or PEF variability)

Rationale:

Despite international guidelines recommending objective testing to establish an asthma diagnosis, the condition is often diagnosed and treated based solely on clinical assessment. Symptoms such as cough, wheezing, and dyspnea are nonspecific and may be caused by other conditions. Studies show that up to one-third of patients diagnosed with asthma do not exhibit signs of the disease when objectively tested. A misdiagnosis of asthma can delay the identification of an underlying condition (which may be serious) and result in unnecessary medication use, leading to potential side effects and increased healthcare costs. (This recommendation does not apply to patients who cannot undergo objective testing, such as young children.) 

References:

• Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2021. Available from: www.ginasthma.org.
• British Thoracic Society/Scottish Intercollegiate Guidelines Network. BTS/SIGN British guideline on the management of asthma [Internet].
• Aaron SD, et al. Reevaluation of Diagnosis in Adults With Physician-Diagnosed Asthma. JAMA. 2017 Jan 17;317(3):269-279. PMID: 28114551.