Table 2.

Diagnostic criteria for asthma in adults, adolescents, and children 6–11 years.

1. HISTORY OF VARIABLE RESPIRATORY SYMPTOMS
Feature	Symptoms or features that support the diagnosis of asthma
Wheeze, shortness of breath, chest tightness and cough (Descriptors may vary between cultures and by age)	• More than one type of respiratory symptom (in adults, isolated cough is seldom due to asthma) • Symptoms occur variably over time and vary in intensity • Symptoms are often worse at night or on waking • Symptoms are often triggered by exercise, laughter, allergens, cold air • Symptoms often appear or worsen with viral infections
2. CONFIRMED VARIABLE EXPIRATORY AIRFLOW LIMITATION
Feature	Considerations, definitions, criteria
2.1 Documented* expiratory airflow limitation	At a time when FEV1 is reduced, confirm that FEV1/FVC is reduced compared with the lower limit of normal (it is usually >0.75–0.80 in adults, >0.90 in children)
AND
2.2 Documented* excessive variability in lung function* (one or more of the following):	The greater the variations, or the more occasions excess variation is seen, the more confident the diagnosis. If initially negative, tests can be repeated during symptoms or in the early morning.
• Positive bronchodilator (BD) responsiveness (reversibility) test	Adults: increase in FEV1 of >12% and >200 mL (greater confidence if increase is >15% and >400 mL). Children: increase in FEV1 by >12% predicted Measure change 10–15 min after 200–400 mcg salbutamol (albuterol) or equivalent, compared with pre-BD readings. Positive test more likely if BD withheld before test: SABA ≥ 4 h, twice-daily LABA 24 h, once-daily LABA 36 h
• Excessive variability in twice-daily PEF over 2 weeks	Adults: average daily diurnal PEF variability >10%a Children: average daily diurnal PEF variability >13%a
• Significant increase in lung function after 4 weeks of anti-inflammatory treatment	Adults: increase in FEV1 by >12% and >200 mL (or PEF2 by >20%) from baseline after 4 weeks of treatment, outside respiratory infections
• Positive exercise challenge test	Adults: fall in FEV1 of >10% and >200 mL from baseline Children: fall in FEV1 of >12% predicted, or PEF >15%
• Positive bronchial challenge test (usually only for adults)	Fall in FEV1 from baseline of ≥20% with standard doses of methacholine, or ≥15% with standardized hyperventilation, hypertonic saline or mannitol challenge
• Excessive variation in lung function between visits (good specificity but poor sensitivity)	Adults: variation in FEV1 of >12% and >200 mL between visits, outside of respiratory infections Children: variation in FEV1 of >12% in FEV1 or >15% in PEFb between visits (may include respiratory infections)

Source: Box 1–2 in GINA 2022. Reproduced with permission from ref. ¹¹.

BD bronchodilator (SABA or rapid-acting LABA), FEV₁ forced expiratory volume in 1 s, ICS inhaled corticosteroid, LABA long-acting beta₂ agonist, PEF peak expiratory flow (highest of three readings), SABA short-acting beta₂ agonist.

^aDaily diurnal PEF variability is calculated from twice daily PEF as (day’s highest minus day’s lowest) divided by (mean of day’s highest and lowest), averaged over 1 week.

^bUse the same PEF meter each time, as PEF may vary by up to 20% between different meters.