Abstract:

In China, bronchial asthma has emerged as the second most prevalent respiratory disease, with mild asthma constituting 50%-70% of the reported cases. The challenges in diagnosing mild asthma arise from the subtle or atypical symptoms exhibited by patients, coupled with the absence of characteristic wheezing sounds. Notably, pulmonary function tests frequently yield normal indices for large airway functions, contributing to a significant misdiagnosis rate exceeding 70%. This high misdiagnosis rate results in patients seeking medical care repeatedly， and some cases receiving inappropriate treatments, with incresed the risk of progressing to moderate or severe asthma, experiencing acute attacks, and facing the potential threat of mortalitydeath. About one-third of asthma deaths occur in mild asthma. Furthermore, the predominant focus on symptom relief rather than the effective control of airway inflammation raises significant concerns regar-ding the diagnosis and treatment of mild asthma in China. In response, the "Expert consensus on the diagnosis, treatment and management of mild bronchial asthma in China (2023 edition)" introduces two diagnostic pathways, namely definitive and presumptive diagnosis, with the aim of enhancing diagnostic accuracy and standardizing treatment approaches. Based on the limitations associated with methods for definitive diagnosis (such as a bronchodilator test's positive rate less than 10% in mild asthma patients and the low clinical implementation rate of bronchial provocation tests)， and an understanding of the pathophysiological mechanisms of small airway dysfunction, a presumptive diagnosis pathway to address these inherent shortcomings is proposed. Initially, a singular pulmonary function test is employed for presumptive diagnosis, integrating small airway function with airway inflammation indices. The model is fine-tuned based on age and gender considerations. The assessment of large and small airway reversibility in patients with negative bronchodilator tests serves as a pivotal guide for diagnostic treatment, minimizing the risks of misdiagnosis and overdiagnosis. Treatment and management strategies are selected based on the level of symptom control, with an emphasis on anti-inflammatory approaches. Employing a patient-centered shared decision-making model and implementing an "assessment-adjustment-review" asthma management cycle to individualize precision management is executed to establish diagnostic and treatment strategies for mild asthma, enhancing the overall standard of care for mild asthma.

Key words: Bronchial asthma, Disease severity, Diagnostic capacity