Asthma is one of the most common respiratory diseases, yet diagnosing it is often difficult. The primary characteristic of the disease is its unpredictability—typical symptoms such as coughing, wheezing, or chest tightness are episodic and can change daily. Often, a patient’s lung function is completely normal at the moment of a clinic visit, which can mislead a physician.
Because of this variable nature, international guidelines recommend that a diagnosis should not be made based on the clinical picture alone. Objective evidence is essential, which is why Spirometry, the Bronchodilator Response (BDR) test, and daily monitoring of Peak Expiratory Flow (PEF) are used. These methods allow us to detect airway narrowing and sensitivity.
However, in real-world practice, implementing international standards faces serious obstacles. Traditional spirometry requires significant time and resources. For patients, maintaining daily paper diaries to record subjective and objective signs is so inconvenient that the data recorded is often inaccurate and unreliable.
The result is a diagnostic imbalance: in low-income countries, asthma often remains undiagnosed, while in developed countries, over-diagnosis is common. Ultimately, both cases harm the patient – one through delayed treatment and the other through unnecessary medication.
The ADVERT Study: Digital Solutions
A Swedish study suggests that the answer to this diagnostic challenge lies in digital technology. Home spirometry integrated with a smartphone ensures maximum data accuracy and eliminates the need for repeated clinic visits.
Through the AsthmaTuner platform, patients monitored their lung function indicators in real-time over an extended period. This method made it possible to reconstruct a dynamic picture of breathing and capture important nuances that are missed during a one-time clinical examination.
The ADVERT study, conducted in Stockholm between 2020 and 2023, included 146 patients (aged 6 and older) with asthma symptoms. After initial training by nurses, patients mastered the spirometry technique for both clinical and home use.
During a 2-4 week monitoring phase, patients measured their (Forced Expiratory Volume in the first second)and PEF twice a day at home. The platform checked the quality of testing in real-time according to international (ATS/ERS) standards, automatically selecting the most valid result from three attempts and immediately sending the data to the physician’s portal.
The study revealed a striking imbalance between traditional and digital diagnostics. The standard Bronchodilator Response (BDR) test was positive in only 5-6% of patients, confirming that a single study conducted in a clinical setting has low sensitivity.
Data analysis allowed scientists to formulate a practical diagnostic criterion: to verify asthma with high probability, it is sufficient to record just two positive instances of daily variability during the observation period. Consequently, the sensitivity of diagnosis using the PEF method reached 76%, while the same indicator for standard guideline tests in the same group was only 8.5%.
Researchers emphasize that static lung function indicators, such as the ratio, should not be used in isolation. To optimize diagnostic accuracy, these data must be considered in combination with dynamic variability indicators and the bronchodilator test.
Performing spirometry at home proved to be completely safe and compatible with primary healthcare (no adverse events were recorded during the study). High patient engagement was evidenced by a 71% completion rate for planned measurements—a significantly high result for remote monitoring.
Ultimately, using this structured protocol, physicians were able to make a well-founded diagnosis in 80% of patients. Such a systemic approach significantly reduces clinical uncertainty and helps specialists differentiate asthma from other conditions such as anxiety syndromes, gastroesophageal reflux, and others.
Source: nature
