To examine the changes in diagnostic criteria for asthma in the GINA updates from 2023 to 2025 and their impact on sensitivity and specificity.
Key Findings:
Removal of airflow limitation (AFL) in 2024 increased asthma diagnoses from 27% to 63%.
Sensitivity improved from 46% to 96% with the removal of AFL, while specificity decreased from 100% to 67%.
The addition of type 2 inflammatory biomarkers in 2025 resulted in 9 additional asthma diagnoses, with 5 being false positives.
Interpretation:
The changes in GINA guidelines have increased the sensitivity for asthma diagnosis but also raised the risk of overdiagnosis, necessitating careful consideration by clinicians.
Limitations:
No widely accepted criterion standard for asthma diagnosis, which may affect the applicability of findings.
The study's findings may not be generalizable due to the specific population studied.
Conclusion:
The GINA pathway has shifted from a 'rule-in' to a 'rule-out' approach for asthma diagnosis, which may lead to a higher rate of overdiagnosis, highlighting the need for careful clinical judgment.
