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Original research
Lung function and asthma control in school-age children managed in UK primary care: a cohort study
  1. David KH Lo1,2,
  2. Caroline S Beardsmore3,
  3. Damian Roland4,5,
  4. Mathew Richardson6,7,
  5. Yaling Yang8,
  6. Lesley Danvers2,
  7. Andrew Wilson9,
  8. Erol A Gaillard2,3
  1. 1 Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester College of Life Sciences, Leicester, UK
  2. 2 Paediatric Respiratory Medicine, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3 Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester, UK
  4. 4 SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
  5. 5 Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, UK
  6. 6 Leicester NIHR Biomedical Research Centre, National Institute for Health Research, Leicester, UK
  7. 7 Department of Respiratory Sciences, University of Leicester College of Life Sciences, Leicester, UK
  8. 8 Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
  9. 9 Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Erol A Gaillard, Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester, Leicester LE2 7LX, UK; eag15{at}le.ac.uk

Abstract

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.

  • asthma in primary care
  • paediatric asthma
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Footnotes

  • Twitter @David__Lo

  • Contributors EAG, DL, CB, DR, MR, YY and AW participated in the initial design of the study. DL and LD were responsible for data collection and providing training to the general practices. DL was responsible for data analyses and initial manuscript preparation with input from EAG and CB. Statistical input was provided by MR. All coauthors contributed to the interpretation of results, and provided revisions and approval of the final manuscript. YY was supported by the Oxford NIHR Biomedical Research Centre duing this study.

  • Funding This study was funded from grants provided by the Midlands Asthma and Allergy Research Association (MAARA) and Circassia Pharmaceuticals to EAG. DL was funded by Health Education East Midlands.

  • Competing interests EAG: consultancy work for Boehringer Ingelheim in November 2016 and Anaxsys in July 2018 with money paid to the institution (University of Leicester), Investigator-led research grant from Circassia and Gilead. Research collaboration with Medimmune. Travel grants from Vertex. YY: was supported by the Oxford NIHR Biomedical Research Centre during this study.

  • Patient consent for publication Not required.

  • Ethics approval Ethics approval was obtained from the NHS Research Ethics Committee (16/EM/0162).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available on reasonable request.

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