{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,18]],"date-time":"2026-05-18T22:16:18Z","timestamp":1779142578488,"version":"3.51.4"},"reference-count":38,"publisher":"European Respiratory Society (ERS)","issue":"3","license":[{"start":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T00:00:00Z","timestamp":1769731200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001711","name":"Schweizerischer Nationalfonds zur F\u00f6rderung der Wissenschaftlichen Forschung","doi-asserted-by":"publisher","award":["SNF 320030_212519"],"award-info":[{"award-number":["SNF 320030_212519"]}],"id":[{"id":"10.13039\/501100001711","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["publications.ersnet.org"],"crossmark-restriction":true},"short-container-title":["ERJ Open Res"],"accepted":{"date-parts":[[2025,11,24]]},"published-print":{"date-parts":[[2026,5]]},"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Clinical practice guidelines for asthma diagnosis are rarely evaluated in real-life practice. Within the Swiss Paediatric Airway Cohort (SPAC), we initiated the SPAC-asthma project to develop a standardised diagnostic approach for school-aged asthma, based on the algorithm recommended by the European Respiratory Society (ERS) guideline. Here, we report the development and feasibility of this approach after implementation across multiple paediatric pulmonology clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We used a modified Delphi process with paediatric pulmonologists from participating clinics to tailor the ERS algorithm for feasible implementation in children aged 5\u201317\u2005years with suspected asthma. Key adaptations included selection of initial tests, criteria for further testing, test cut-offs, the role of medication trials, and follow-up procedures. At 1\u2005year after implementation, we evaluated adherence to the adapted approach at four clinics and explored the reasons for any deviations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The final SPAC-asthma approach included spirometry, fractional exhaled nitric oxide and allergy testing as initial tests, followed by either bronchodilator reversibility testing, bronchial challenge test or medication trial. Among the 236 children included after 1 year (median age 9\u2005years), overall adherence to the approach was 77% (182 of 236, 95% CI 72\u201383%). Deviations were due to practice-related (\n                      <jats:italic>e.g.<\/jats:italic>\n                      different criteria for bronchial obstruction), patient-related (\n                      <jats:italic>e.g.<\/jats:italic>\n                      inability to perform spirometry) and logistical reasons (\n                      <jats:italic>e.g.<\/jats:italic>\n                      scheduling difficulties), occurring in 44%, 33% and 22% of the deviations, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The diagnostic approach adapted from the ERS guidelines was feasible in most cases, but the observed deviations highlighted the need for flexibility when applying guidelines in real-world settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1183\/23120541.01246-2025","type":"journal-article","created":{"date-parts":[[2026,1,30]],"date-time":"2026-01-30T12:35:17Z","timestamp":1769776517000},"page":"01246-2025","update-policy":"https:\/\/doi.org\/10.1183\/ers-crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Real-world feasibility of adapted European Respiratory Society asthma diagnosis guidelines for school-aged children"],"prefix":"10.1183","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1590-3838","authenticated-orcid":false,"given":"Mari","family":"Sasaki","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8036-2092","authenticated-orcid":false,"given":"Myrofora","family":"Goutaki","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sarah","family":"Glick","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0284-9705","authenticated-orcid":false,"given":"Sylvain","family":"Blanchon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Karin","family":"Hoyler","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5239-1571","authenticated-orcid":false,"given":"Philipp","family":"Latzin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7284-4251","authenticated-orcid":false,"given":"Alexander","family":"Moeller","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicolas","family":"Regamey","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8957-2002","authenticated-orcid":false,"given":"Claudia E.","family":"Kuehni","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"on behalf of the SPAC Study Team","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"81","published-online":{"date-parts":[[2026,1,30]]},"reference":[{"key":"2026051803150767000_12.3.01246-2025.1","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2022-062158"},{"key":"2026051803150767000_12.3.01246-2025.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2023.08.017"},{"key":"2026051803150767000_12.3.01246-2025.3","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00184511"},{"key":"2026051803150767000_12.3.01246-2025.4","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-007047"},{"key":"2026051803150767000_12.3.01246-2025.5","doi-asserted-by":"crossref","first-page":"593894","DOI":"10.3389\/fphar.2020.593894","article-title":"Even high-quality CPGs seldom include implementation strategies","volume":"11","author":"de Vasconcelos","year":"2020","journal-title":"Front Pharmacol"},{"key":"2026051803150767000_12.3.01246-2025.6","doi-asserted-by":"crossref","first-page":"223","DOI":"10.1186\/s12887-021-02693-1","article-title":"Quality of pediatric clinical practice guidelines","volume":"21","author":"Liu","year":"2021","journal-title":"BMC Pediatr"},{"key":"2026051803150767000_12.3.01246-2025.7","unstructured":"National Institute for Health and Care Excellence (NICE). Asthma: diagnosis, monitoring and chronic asthma management (guideline NG80). Date last updated: 22 March 2021. Date last accessed: 13 August 2024. www.nice.org.uk\/guidance\/ng80"},{"key":"2026051803150767000_12.3.01246-2025.8","unstructured":"Global Initiative for Asthma . Global Strategy for Asthma Management and Prevention, 2019. Date last updated: June 2019, Date last accessed: 13 August, 2024. https:\/\/ginasthma.org\/wp-content\/uploads\/2019\/06\/GINA-2019-main-report-June-2019-wms.pdf"},{"key":"2026051803150767000_12.3.01246-2025.9","unstructured":"British Thoracic Society SIGN . British guideline on the management of asthma. Date last updated: July 2019, Date last accessed: 13 August 2024. www.sign.ac.uk\/our-guidelines\/british-guideline-on-the-management-of-asthma\/"},{"key":"2026051803150767000_12.3.01246-2025.10","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.00132-2020"},{"key":"2026051803150767000_12.3.01246-2025.11","doi-asserted-by":"publisher","DOI":"10.1183\/13993003.04173-2020"},{"key":"2026051803150767000_12.3.01246-2025.12","doi-asserted-by":"crossref","unstructured":"Moeller A , Barazzone C , Barben J , et al. 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