Introduction Despite the common nature of asthma there is no gold standard test for diagnosis. Both under- and over-diagnosis of childhood asthma in primary care have been reported but there is no UK data.^1,2 Diagnostic algorithms including objective tests have been proposed but not implemented following a recent NICE consultation. Concerns regarding efficacy and additional resources needed in primary care to provide these tests have delayed implementation.

Aims

• Evaluate practice based barriers to spirometry and exhaled nitric oxide (eNO) testing in children aged 5–16 years

• Examine how training impacts on the utilisation of objective tests on asthma diagnosis

Methods Currently 3 GP surgeries of different sizes and demographics participate in this 2-year project.

Initial face-to-face (F2F) meetings and questionnaires are conducted at each practice to identify barriers to implementation. Paediatric spirometry and eNO training is provided to practice staff (F2F theory session plus practical supervision).

All children on the practice asthma register AND those who received asthma medications within the last 12 months (but not on register) are invited for review.

Data collection (medications, exacerbations, asthma diagnosis etc.) and quality of life questionnaires are conducted at baseline and then again at 6 months by post and repeat review of electronic records

Results Recruitment commenced on 01/06/2016.

To date, nursing staff at two practices have received training and 10 children (5–15 years) have been recruited (11 eligible) in the course of 3 asthma review clinics. Spirometry and eNO were successful in 8 of these children.

Practice staff have expressed concerns regarding funding, additional clinic time and staff training as the main barriers against implementation.

Conclusions Our early data suggests that providing spirometry and eNO for children in general practice is achievable with our training package. Both the training package and clinic structure are being refined to improve time and cost-efficiency.

This study (which when complete will contain a health economic analysis) will provide important evidence to inform NHS decision makers and primary care stakeholders on the usefulness of objective testing in children diagnosed and/or under investigation for asthma in general practice.

References

1. Br J Gen Pract 2016;66(644):e152–7.

2. BMJ 1998;316:118–124.