So Alana, if I'm a primary care NP and I have asthmatic patients, how can I test for the phenotype for asthma for my patients that I really need to understand?

So I typically tell my primary care folks to think about asthma in really three stages.

First, you're going to gather your history, just like Felicia is talking about, asking about when did the asthma start? What are their common symptoms? Do they have any history of atopy, any family history of asthma? You're really looking for those signs and symptoms that are classically asthma, right? The variable wheeze, dyspnea, chest tightness, cough, nighttime awakening, all of the things that Felicia really did a great job of highlighting and talking about.

The second part of it is really looking at the physiology.

So here is where you're going to need some testing, right? And so you're going to need to get a spirometry to diagnose that asthma and not just go based on the person looking and sounding like asthma, but actually getting the proof that they have asthma, that they do have an obstructive lung disease on spirometry.

And Gina actually just recently updated the recommendation in 2026 that said we could even use peak flow measuring and looking at the variability in peak flow to actually make the diagnosis of asthma, which is huge globally.

So because we don't all have access to spirometry, but looking at differences in either FEV1 through spirometry or through peak flow, looking at a difference of at least 10% of variability really can have you make the confirmation of the diagnosis of asthma.

And I know I want to talk about oral corticosteroid use in a second, but just in general, we've got a lot of agents out there, including biologics, right? Yeah.