Are new monitoring tools on the horizon? Making the most of pulmonary function testing in the diagnosis of asthma

Although the results of a thorough history and physical examination often suggest the diagnosis of asthma, confirmatory testing is required and may be helpful in more subtle cases. Spirometry before and after bronchodilator administration is the first step for the initial diagnosis; it also is an important component of the long-term assessment of asthma control. When the results of spirometry are normal in a patient in whom asthma is suspected, bronchoprovocation challenge testing with methacholine is generally considered the next diagnostic step. Numerous alternative methods of bronchoprovocation testing have been developed, such as the challenge with adenosine 5′-monophosphate. Novel methods such as the forced oscillation technique and the measurement of exhaled nitric oxide hold promise for more effective diagnosis and monitoring of asthma in the future.