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Functional Examination of the Upper and Lower Airways in Asthma and Respiratory Allergic Diseases: Considerations in the Post–SARS-CoV-2 Era

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, 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, 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, Madrid, Spain
7Department of Allergy, Consorci Sanitari de Terrassa; Clínica Diagonal, Barcelona, Spain
8Department of Allergy, Fundación Jiménez Díaz, Madrid, Spain
9CIBER de Enfermedades Respiratorias (CIBERES), Spain

J Investig Allergol Clin Immunol 2021; Vol 31(1) : 17-35
doi: 10.18176/jiaci.0625

Airway examination procedures can potentially transmit infectious diseases to patients and to the health care professionals who perform them via various mechanisms. The COVID-19 pandemic has halted most of the activity of the clinics and laboratories involved in assessment of lung and nasal function, and clear recommendations in this regard have been made. Today, we still do not know for sure what its consequences will be in the short or long term, since important gaps remain in our knowledge of aspects as fundamental as virus transmission mechanisms, pathophysiology, immune response, and diagnosis.
In this review, we study the examination techniques used to assess patients with respiratory allergy, asthma, and associated diseases during this period and highlight their possible advantages and disadvantages. Therefore, we focus on exploring the entire upper and lower airways, from the perspective of the safety of both health professionals and patients and their specific characteristics. We also analyze the intrinsic value of these interventions in terms of diagnosis and patient management.
The changing situation of COVID-19 may mean that some of the assertions presented in this review will have to be modified in the future. While we seek to ensure a consistently broad approach, some differences in operational details may apply owing to local regulations.

Key words: Asthma, Allergic rhinitis, Bronchial challenge, Inflammatory biomarkers, Lung function tests, Upper airway examination