Asthma

🧭 When to suspect

Suspect asthma in anyone with more than one of the key respiratory symptoms – wheeze, cough, breathlessness or chest tightness – that is episodic and variable, characteristically worse at night or in the early morning. The diagnosis is strengthened by symptoms that are provoked by recognisable triggers (viral infections, exercise, cold air, allergens, emotion) and by a personal or family history of atopy (eczema, allergic rhinitis).

The single most important change in recent UK practice is that asthma is now a two-part diagnosis: a suggestive clinical history plus a supporting objective test. Do not confirm asthma on history alone – code as “suspected asthma” until a test confirms it, and record the basis for the diagnosis in the notes. Remember too that expiratory wheeze is often absent between episodes, and that a normal examination never excludes asthma.

This guidance reflects the 2024 joint BTS/NICE/SIGN guideline (NG245), which replaced NG80 and overhauled both the diagnostic pathway and inhaled treatment. NG245 covers diagnosis, monitoring and chronic management; acute attacks and difficult asthma are covered separately (NG244, retaining the BTS/SIGN recommendations).

Source: NICE NG245