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.

Additional Metadata
Persistent URL dx.doi.org/10.1038/s41533-020-00202-y, hdl.handle.net/1765/131354
Journal npj Primary Care Respiratory Medicine
Citation
Bins, J.E., Metting, E.I., Muilwijk-Kroes, J.B., Kocks, JWH, & Veen, J. (2020). The use of a direct bronchial challenge test in primary care to diagnose asthma. npj Primary Care Respiratory Medicine, 30(1). doi:10.1038/s41533-020-00202-y