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Introduction In the GINA 2024 strategy report the requirement for documented airflow limitation was removed for establishing a diagnosis of asthma, and criteria amended to a history of typical variable respiratory symptoms with confirmed variable expiratory airflow.Aim To determine the effect of removing airflow limitation as a criterion for asthma diagnosis on the sensitivity and specificity of the GINA guidelines.Methods Adults presenting with respiratory symptoms but not receiving inhaled corticosteroids were referred from primary care for comprehensive diagnostic evaluation as part of the RADicA study. Asthma diagnosis (reference standard) was established by a panel of asthma specialists based on clinical history, physical examination, spirometry, bronchodilator reversibility (BDR), fractional exhaled nitric oxide (FeNO), peak expiratory flow variability, bronchial challenge testing, allergy testing, blood eosinophil counts, and treatment response to 4–12 weeks ICS. The sensitivity and specificity of the GINA 2023 criteria for diagnosing asthma was calculated and compared to the GINA 2024 criteria.Results 118 adults [75 female, mean (SD) age 36 (12) y] with a definitive diagnostic outcome from the asthma specialists: 70 (59%) had asthma, were included in the study. 32 (27%) patients met the GINA 2023 criteria for asthma, compared to 74 (63%) with the updated GINA 2024 guidance. Consequently, the sensitivity improved from 46% (95% CI: 34–58%) to 90% (80–96%), whilst specificity decreased from 100% (93–100%) to 77% (63–88%) ( table 1). The overall accuracy improved with the updated guidance from 68% (59–76%) to 85% (77–91%) (table 1).Abstract S49 Table 1Performance of GINA 2023 and GINA 2024 strategy report criteria for the diagnosis of asthma compared to expert panel objective evidence review Sensitivity Specificity PPV NPV Accuracy GINA 2023 (%, 95% CI) 46 (34–58) 100 (93–100) 100 (89–100) 56 (50–61) 68 (59–76) GINA 2024 (%, 95% CI) 90 (80–96) 77 (63–88) 85 (77–91) 84 (92–92) 85 (77–91) Abbreviations: GINA, Global Initiative for Asthma; PPV, positive predictive value; NPV, negative predictive value.Conclusion The removal of documented airflow limitation in the GINA 2024 strategy report results in significantly fewer missed cases of asthma and improves the overall diagnostic accuracy.