Childhood Asthma Management In Primary Care – Implementation Of Exhaled Nitric Oxide And Spirometry Testing

The National Institute for Health and Care Excellence recommends spirometry and exhaled nitric oxide (eNO) testing in children from five years for diagnosis, and spirometry for asthma monitoring. However, there is limited paediatric spirometry and eNO data in UK primary care to support this.

Using the principles of a type 3 hybrid study design, this was a prospective observational study with the dual objectives of exploring the implementation and clinical outcomes related to provision of spirometry and eNO testing for children in general practice. Firstly, to quantify the training and capacity requirements needed in general practice to deliver routine spirometry and eNO testing for children, and secondly to explore what additional information these tests provide and how they relate to current symptoms and asthma attacks.

Ten general practices (GP) participated. GP staff were trained to perform and interpret spirometry and eNO. Children aged 5-16 with suspected or doctor-diagnosed asthma were invited to attend a review. Spirometry and eNO data, Asthma Control Test (ACT) scores, and number of UHAs in the previous six months were recorded. Follow up ACTs were sent out, and patient records were reviewed, six months later.

We demonstrated that it is possible to train GP staff to obtain quality spirometry and eNO data from most children in the GP setting, and that the tests are acceptable to staff and families.

Of the 612 children recruited, 24% had abnormal spirometry and 36% had raised eNO. 54% of children reporting good asthma control had abnormal spirometry or raised eNO, whilst 49% of children reporting poor control had normal tests. We conclude that abnormal lung function is prevalent in children managed for asthma in primary care, and assessing asthma based on symptoms’ alone is inadequate. The role of objective test targeted children’s asthma management in primary care warrants further study.