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Effectiveness of paediatric asthma hubs: a clinical pilot study
Ali Hakizimana1,2, David K H Lo1,2, Damian Roland3,4
1Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK.
Insights
UK children with asthma face poor outcomes due to limited access to care. Pilot asthma hubs provide post-attack reviews and diagnostic testing, proving a feasible model for improving paediatric asthma management and identifying high-risk patients.
Area of Science:
- Pediatric pulmonology
- Respiratory medicine
- Healthcare innovation
Background:
- Children and young people (CYP) in the UK experience worse asthma outcomes compared to other high-income countries.
- Contributing factors include limited access to quality asthma reviews, diagnostic tests, and inconsistent post-attack care.
- A pilot asthma hub for CYP was established to address these challenges.
Purpose of the Study:
- To investigate the feasibility and effectiveness of paediatric asthma hubs.
- To provide post-asthma attack reviews for CYP.
- To offer asthma education, diagnostic lung function tests, and treatment optimization.
Main Methods:
- A clinical pilot study involving CYP aged 4-17 with uncontrolled or post-attack asthma.
- Participants received structured clinical assessments including National Institute for Health and Care Excellence (NICE) recommended diagnostic tests.
- Tests included spirometry, bronchodilator reversibility (BDR), and fraction of exhaled nitric oxide (FeNO).
Main Results:
- Of 312 referred CYP, 266 (85.3%) attended appointments; median review time was 2 days.
- Asthma was confirmed in 73 (31.6%) of 231 CYP completing first-line tests.
- Twenty-two percent of children with normal baseline spirometry showed significant bronchodilator reversibility (≥12%).
Conclusions:
- Paediatric asthma hubs are a feasible care model for post-attack reviews and identifying high-risk CYP.
- Diagnostic confirmation was achieved in a significant proportion of CYP using spirometry, BDR, and FeNO.
- The hub model shows potential for improving asthma management in children and young people.
Background:
Children and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub for CYP, to investigate the feasibility and effectiveness of hubs, in providing postattack reviews along with providing asthma education, the opportunity to carry out diagnostic lung function tests and optimise treatment.
Methods:
Clinical pilot study including CYP aged 4-17 years referred to the hub with uncontrolled asthma or postattack from November 2021 to April 2022. CYP received a structured clinical assessment including National Institute for Health and Care Excellence (NICE) first-line diagnostic investigations for asthma including spirometry, bronchodilator reversibility (BDR) and fraction of exhaled nitric oxide (FeNO).
Results:
Of 312 CYP referred (mean age 8.6±3.2 years; 42% women), 266 (85.3%) attended their appointment. Median time from referral to review was 2 days (IQR 1-3). Three CYP (1.1%) were severely unwell at review and required further hospital treatment. In the 231 CYP who completed first-line tests, asthma was confirmed for 73 (31.6%) based on NICE diagnostic criteria for CYP. Twenty-two per cent of children with normal baseline spirometry had ≥12% BDR.
Conclusion:
Paediatric asthma hubs are a feasible model of care to deliver CYP postasthma attack reviews and identify high-risk patients requiring further treatment. Spirometry, BDR and FeNO testing allowed diagnostic confirmation in a significant proportion of CYP.
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