Lung function and asthma control in school-age children managed in UK primary care: a cohort study
journal contributionposted on 2019-12-06, 10:09 authored by David K H Lo, Caroline S Beardsmore, Damian Roland, Mathew Richardson, yaling yangyaling yang, Lesley Danvers, Andrew Wilson, Erol A Gaillard
Background: Spirometry and 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 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 > 35ppb, and 41.8% reported poor control. Fifty-four percent 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 six months preceding review to 0.20/child over the six months following review (p=0.0004). Median asthma control test (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.
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.
CitationThorax, 2019. doi:10.1136/thoraxjnl-2019-213068
Author affiliationDepartment of Respiratory Sciences. Leicester NIHR Biomedical Research Centre
- AM (Accepted Manuscript)