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Lung function and asthma control in school-age children managed in UK primary care: a cohort study
David Kh Lo1,2, Caroline S Beardsmore3, Damian Roland4,5
1Department of Respiratory Sciences. Leicester NIHR Biomedical Research Centre (Respiratory theme), University of Leicester College of Life Sciences, Leicester, UK.
Insights
Abnormal lung function and exhaled nitric oxide (FeNO) are common in children with asthma managed in primary care. Objective testing is crucial for identifying children at high risk of severe asthma attacks, as symptom scores alone are insufficient.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Primary Care Research
Background:
- Spirometry and fraction of exhaled nitric oxide (FeNO) are standard for asthma monitoring in specialist settings.
- UK guidelines recommend spirometry for asthma monitoring from age 5 in all care settings.
- Limited data exist on spirometry and FeNO use for children with asthma in UK primary care.
Purpose of the Study:
- To determine the prevalence of abnormal spirometry and FeNO in primary care-managed pediatric asthma.
- To investigate the association between abnormal lung function/FeNO and asthma control.
- To explore the relationship with unplanned healthcare attendances (UHA) in children with asthma.
Main Methods:
- Prospective observational cohort study involving children aged 5-16 years with suspected or diagnosed asthma.
- Data collected in UK general practices during asthma reviews.
- Measurements included spirometry, FeNO, Asthma Control Test (ACT) scores, and UHA history.
Main Results:
- 23.5% of children had abnormal spirometry; 36.0% had raised FeNO (≥35 ppb).
- 41.8% reported poor asthma control; 54% with good control had abnormal spirometry and/or raised FeNO.
- Asthma reviews led to reduced UHAs and improved ACT scores post-intervention.
Conclusions:
- Abnormal lung function and FeNO are prevalent in children with asthma reviewed in primary care.
- Objective measures (spirometry, FeNO) correlate poorly with symptom-based asthma control scores.
- Relying solely on symptoms for asthma monitoring may miss high-risk children.
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.
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