Abnormal lung function highly prevalent in asthmatic children managed in UK primary care

  • Lo DK & al.
  • Thorax
  • 30 Oct 2019

  • curated by Sarfaroj Khan
  • UK Clinical Digest
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  • Abnormal lung function and exhaled nitric oxide (FeNO) are highly prevalent in children with asthma managed in primary care and correlates poorly with patient-reported symptom scores.
  • Finding suggests that a symptoms-based assessment alone is inadequate, and is likely to miss children at high risk of a future severe asthma attack.

Why this matters

  • The National Institute for Health and Care Excellence recommends spirometry for asthma monitoring in children aged ≥5 years and FeNO measurements to support asthma management in people who are symptomatic despite using inhaled corticosteroids.
  • Spirometry and FeNO are rarely measured in the management of children or adults in the UK primary care.

Study design

  • Prospective observational cohort study of 612 children (aged 5-16 years) with asthma attending an asthma review in UK general practice.
  • Spirometry, FeNO, asthma control test (ACT)/ childhood asthma control test (CACT) scores and number of unplanned health care attendances (UHAs) were assessed.
  • Funding: The Midlands Asthma and Allergy Research Association and others.

Key results

  • Of 612 children, 135 (23.5%) had airflow obstruction, 171 (36%) had raised FeNO ≥35 parts per billion and 256 (41.8%) had poor asthma control.
  • Overall, 46% of children reporting good asthma control (ACT/CACT score >19) had abnormal spirometry and/or raised FeNO.
  • At follow-up, the mean number of UHAs fell from 0.31 (standard error of mean [SEM], 0.03) per child in the 6 months preceding review to 0.20 (SEM, 0.02) child over the 6 months following review (P=.0004).
  • Overall, median ACT scores improved from 20 (interquartile range [IQR], 17-23) to 22 (IQR 19-24; P=.032), and children’s ACT score from 21 (IQR, 19-24) to 23 (IQR, 19.5-25; P<.0001 in the months following review.>


  • Absence of a control arm.
  • Only more symptomatic children attended the review.