Lung Function in Primary Care - Thorax - Final.docx (96.78 kB)
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Lung function and asthma control in school-age children managed in UK primary care: A cohort study

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journal contribution
posted on 26.03.2020, 12:11 by DK Lo, CS Beardsmore, D Roland, M Richardson, Y Yang, L Danvers, A Wilson, EA Gaillard
Background: Spirometry and fraction of exhaled nitric oxide (FeNO) are commonly used in specialist centres to monitor children with asthma. The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring from 5 years in all healthcare settings. There is little spirometry and FeNO data in children managed for asthma in UK primary care to support their use. Objectives: To study the prevalence of abnormal spirometry and FeNO in children with asthma managed in primary care and to explore their relationship with asthma control and unplanned healthcare attendances (UHA). Methods: Prospective observational cohort study in children aged 5-16 years with suspected or doctor-diagnosed asthma attending an asthma review in UK general practice. Spirometry, FeNO, asthma control test (ACT) scores and number of UHAs were studied. Results: Of 612 children from 10 general practices, 23.5% had abnormal spirometry, 36.0% had raised FeNO ≥35 parts per billion and 41.8% reported poor control. Fifty-four per cent of children reporting good asthma control had abnormal spirometry and/or raised FeNO. At follow-up, the mean number of UHAs fell from 0.31/child in the 6 months preceding review to 0.20/child over the 6 months following review (p=0.0004). Median ACT scores improved from 20 to 22 (p=0.032), and children's ACT from 21 to 23 (p<0.0001). Conclusions: Abnormal lung function and FeNO are common in children attending for asthma review in primary care and relate poorly to symptom scores. A symptoms-based approach to asthma monitoring without objective testing is likely to miss children at high risk of future severe asthma attacks.

Funding

This study was funded from grants provided by the Midlands Asthma and Allergy Research Association (MAARA) and Circassia Pharmaceuticals to EG. The project fellow (DL) was funded by Health Education East Midlands

History

Citation

Thorax, 2020, 75, 2, 101–107.

Author affiliation

College of Life Sciences

Version

AM (Accepted Manuscript)

Published in

Thorax

Volume

75

Issue

2

Pagination

101-107

Publisher

BMJ Publishing Group

issn

0040-6376

eissn

1468-3296

Acceptance date

23/09/2019

Copyright date

2020

Publisher version

https://thorax.bmj.com/content/75/2/101

Spatial coverage

England

Language

eng

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