🧭 When to suspect

Suspect asthma in anyone with more than one of the key respiratory symptoms that are episodic and variable, characteristically worse at night or in the early morning:

• Wheeze

• Cough

• Breathlessness

• Chest tightness

The diagnosis is strengthened by:

• Symptoms that are provoked by recognisable triggers (viral infections, exercise, cold air, allergens, emotion)

• A personal or family history of atopy (eczema, allergic rhinitis)

In UK practice, 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.

• Record the basis for the diagnosis in the notes.

Beware:

• Expiratory wheeze is often absent between episodes

• 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

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Inside the full topic 🔒 History🔒 Red Flags🔒 Examination🔒 Patient Explanation🔒 Investigations🔒 Management🔒 Non-pharmacological Treatment🔒 Pharmacological Treatment🔒 Inhalers: doses and devices🔒 Acute Asthma – severity and management🔒 Special Notes🔒 Referral Pathways🔒 Take Home Messages

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