Lung function and asthma control in school-age children managed in UK primary care: a cohort study
journal contributionposted on 06.12.2019, 10:09 authored by David K H Lo, Caroline S Beardsmore, Damian Roland, Mathew Richardson, yaling yangyaling yang, Lesley Danvers, Andrew Wilson, Erol A Gaillard
Background: Spirometry and 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 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 > 35ppb, and 41.8% reported poor control. Fifty-four percent 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 six months preceding review to 0.20/child over the six months following review (p=0.0004). Median asthma control test (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.