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Since you’re keen on the details, here is a consolidated "Pocket Guide" to the 2025/2026 BTS/NICE/SIGN thresholds and the diagnostic flow. This summarizes the logic Professor Turner is teaching in these slides.
1. The Pediatric Diagnostic Thresholds (Ages 5–16)
To move a child from "Suspected Asthma" to a "Confirmed Diagnosis," they must hit at least one of these objective markers:
| Test | Positive Result (Confirm) | Notes |
| FeNO | $\ge$ 35 ppb | Measures eosinophilic airway inflammation. |
| BDR (Spirometry) | $\ge$ 12% improvement | Measured in $FEV_1$ after 400mcg Salbutamol. |
| Peak Flow (PEF) | $\ge$ 20% variability | Monitored over 2–4 weeks (twice daily). |
| Blood/Skin Test | Positive | Evidence of sensitization + symptoms is a strong indicator. |
2. The M vs. C Logic
Professor Turner uses these cases to show where the "Art of Medicine" meets the "Science of Guidelines":
The "Rule-In" Case (C)
Profile: Strong family history, eczema, and classic symptoms.
The "Yes": Her FeNO is 38 ppb.
Action: Stop testing. Diagnose and start Step 1 (ICS + SABA) or Step 2 (MART).
The "Grey Area" Case (M)
Profile: No family history, no eczema, symptoms only with colds.
The "Maybe": His FeNO is 28 ppb (The Intermediate Zone: 20–34 ppb).
Action: Do not diagnose yet. Perform Spirometry/BDR. If that is normal, start a 6–12 week trial of treatment and review. If symptoms disappear and return upon stopping the inhaler, the diagnosis is confirmed clinically.
3. The 2026 Treatment Strategy: The End of "SABA-Only"
The most critical takeaway from the November 2024/2025 updates is the shift in how we use the "Blue Inhaler" (SABA).
The Risk: Over-reliance on SABA (using $\ge$ 3 canisters a year) is now officially linked to increased mortality.
The Solution (MART): For children who are uncontrolled on low-dose steroids, the MART (Maintenance and Reliever Therapy) approach is now the preferred Step 2.
Why? Because it ensures that every time the child feels wheezy and takes a puff, they are getting a "boost" of anti-inflammatory steroid alongside the bronchodilator.
4. Key Takeaways for Practice
Symptoms First: Only test if they have the "Triple Threat" (Cough + Wheeze + DIB).
Objective Proof: Don't just give out inhalers; get a FeNO or Spirometry reading first.
The "Suspected" Label: Use the new SNOMED codes for "Suspected Asthma" to keep records accurate while testing is ongoing.
Would you like me to draft a sample "Personalised Asthma Action Plan" (PAAP) based on these 2026 MART guidelines?
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