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Upper and Lower Airways Functional Examination in Asthma and Respiratory Allergic Deseases. Considerations in the SARS-CoV-2 Post-Pandemic Situation

Olaguibel JM1,9, Alobid I2,3,9, Alvarez Puebla M1,9, Crespo-Lessmann A4,9, Domínguez Ortega J5,9, García-Rio F6,9, Izquierdo-Domínguez A2,7, Mullol J3,9, Plaza V4,9, Quirce S5,9, Rojas-Lechuga MJ3, Valvere-Monge M8, Sastre J8,9

1Department of Allergy, Complejo Hospitalario de Navarra, Pamplona, Spain
2Unidad Alergo-Rino, Centro Médico Teknon, Barcelona, Catalonia, Spain
3Unitat de Rinologia & Clínica de l’Olfacte, Servei d’Oto-rino-laringologia, Hospital Clinic Barcelona; Immunoalèrgia Respiratòria Clínica i Experimental, IDIBAPS; Universitat de Barcelona, Barcelona, Catalonia, Spain
4Department of Respiratory Medicine, Hospital de la Santa Creu i Sant Pau, Institut d’Investigació Biomédica Sant Pau (IIB Sant Pau), Universitat Autònoma de Barcelona, Department of Medicine, Barcelona, Spain
5Department of Allergy, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
6Department of Respiratry Medicine, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain. Departamento de Medicina, Facultad de Medicina, Universidad Autónoma de Madrid, Spain
7Department of Allergy, Consorci Sanitari de Terrassa; Clínica Diagonal, Barcelona, Catalonia, Spain
8Department of Allergy, Fundación Jiménez Díaz, Madrid, Spain
9CIBER de Enfermedades Respiratorias (CIBERES), Spain

J Investig Allergol Clin Immunol 2021; Vol. 31(1)
doi: 10.18176/jiaci.0625

Airway examination techniques are procedures that can potentially transmit infectious diseases to both patients and healthcare professionals who perform them, by various mechanisms. The pandemic situation due to the COVID-19 disease has practically halted most of the activity of the clinics and laboratories of pulmonary and nasal function, with clear recommendations in this regard. Being already in the early stages after the peak of the pandemic, we still do not know for sure what its consequences will be in the short or long term, since there are important gaps in the knowledge of aspects as fundamental as the transmission mechanisms of the virus, its pathophysiology and immune response or its diagnosis.
In this review we will examine the different examination techniques available on the assessment of patients suffering from respiratory allergy, asthma and associated diseases, int the postpandemic momentum, highlighting their possible advantages and disadvantages. For this reason, we wanted to focus on exploring the entire upper and lower airways, from the perspective of the safety of both the healthcare professionals and patients and their specific characteristics. And at the same time we will approach the analysis of the intrinsic value that these interventions provide from the point of view of both diagnosis and management of these patients.
The changing situation of this disease may cause some modifications of the assertions presented in this review in the future.While this guidance seeks to ensure a consistent wide approach, some differences in operational details may be applied due to local regulations.

Key words: Asthma, Allergic rhinitis, Bronchaill challenge, Inflammatory biomarkers, Lung function tests, Upper airways examination