Asthma
BioMG follows French guidelines. Adapt it to the guidelines and the tests available where you practise.
Moderate asthma
Laboratory tests
- Testing for inhalant allergens
- Testing for food allergens
- FBC (if the diagnosis of asthma needs supporting, or asthma not controlled on maintenance treatment)if needednon-French guidelineNICE, the BTS and SIGN (2024) have eosinophils or FeNO measured in adults whose history suggests asthma: a count above the laboratory reference interval is enough for the diagnosis, otherwise spirometry follows [2]. This inexpensive test is more than 80% specific, poorly sensitive, and altered by smoking and other allergic diseases [2]. They also request it when asthma remains uncontrolled on a medium-dose inhaled corticosteroid-formoterol despite good adherence: if raised, it leads to referral to a specialist [2]. GINA (2026) sees in it an argument for type 2 asthma, without a low value ruling it out [3], and the German NVL (2024) judges the level of evidence for this diagnostic use to be weak [4]. The SPLF (2021) bases the diagnosis on symptoms and spirometry, and recommends eosinophils in the work-up of severe asthma [5].
Do not order
- Total serum IgE: not recommended in asthmatic patients outside severe asthma and suspected allergic bronchopulmonary aspergillosis [5].
Severe asthma
Laboratory tests
- FBC
- Testing for inhalant allergens
- Testing for food allergens
- Total serum IgE
- Specific IgEif neededDiscordance between reported symptoms and skin prick tests, or skin prick tests not feasible or not interpretable.
- Alpha-1 antitrypsin (if persistent obstruction with early onset, or emphysema with little smoking)if needednon-French guidelineGINA (2026) suggests considering this test, at specialist level, in asthmatic patients with persistent obstruction of early onset, or with emphysema on CT and little smoking [3]. The WHO, cited by the European Respiratory Society (2017), recommends testing every patient with COPD or adult-onset asthma [7]. The short version of the SPLF recommendations (2021) leaves other tests to clinical pointers, without citing this assay [5]. See the “COPD” page.
Allergic bronchopulmonary aspergillosis
Laboratory tests
- FBC
- Total serum IgE
- Specific IgE to Aspergillus fumigatus
- Anti-Aspergillus fumigatus IgG (ELISA screening, confirmation by immunoelectrophoresis or Western blot)
- β-hCGif neededTests before itraconazole or voriconazole in a woman of childbearing potential.
- ASTif neededPre-treatment tests before itraconazole or voriconazole.
- ALTif neededPre-treatment tests before itraconazole or voriconazole.
- GGTif neededPre-treatment tests before itraconazole or voriconazole.
- Serum creatinine with eGFRif neededPre-treatment tests before itraconazole or voriconazole.
Sources (9)
- Santé publique France. Prévalence de l'asthme chez l'adulte en France, données de la cohorte Constances (résumé en ligne).
- National Institute for Health and Care Excellence (NICE), British Thoracic Society (BTS), Scottish Intercollegiate Guidelines Network (SIGN). Asthma: diagnosis, monitoring and chronic asthma management. NICE guideline NG245, 27 novembre 2024.
- Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention. Mise à jour de mai 2026.
- Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF). Nationale VersorgungsLeitlinie Asthma, Langfassung, Version 5.0, 2024.
- Mise à jour des recommandations pour la prise en charge et le suivi des patients asthmatiques adultes sous l’égide de la Société de pneumologie en langue française (SPLF) et de la société pédiatrique de de pneumologie et allergologie.
- Expert Panel Working Group of the National Heart, Lung, and Blood Institute, National Asthma Education and Prevention Program Coordinating Committee ; Cloutier MM, Baptist AP, Blake KV, et al. 2020 Focused Updates to the Asthma Management Guidelines. J Allergy Clin Immunol. 2020;146(6):1217-1270.
- Miravitlles M, Dirksen A, Ferrarotti I, Koblizek V, Lange P, Mahadeva R, et al. European Respiratory Society statement: diagnosis and treatment of pulmonary disease in α1-antitrypsin deficiency. Eur Respir J 2017;50(5):1700610.
- PNDS Aspergillose bronchopulmonaire allergique
- Agarwal R, Sehgal IS, Muthu V, Denning DW, et al. Revised ISHAM-ABPA working group clinical practice guidelines for diagnosing, classifying and treating allergic bronchopulmonary aspergillosis/mycoses. Eur Respir J. 2024;63(4):2400061.