Starting an inhaled corticosteroid before objective testing makes asthma harder to confirm or exclude: FeNO and airway hyper-responsiveness both fall on treatment. A patient labelled asthmatic without a test may stay on inhalers for years without needing them.
- Do spirometry with reversibility, and FeNO where available, before starting an inhaled steroid
- If treatment must start, record the pre-treatment findings
- Recheck the diagnosis in patients whose 'asthma' never improved with treatment
- Remember a normal spirometry between episodes does not exclude asthma
Why it matters
Treatment first often means the diagnosis is never confirmed.
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