Takeaway
- 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 6 months following review.
Limitations
- Absence of a control arm.
- Only more symptomatic children attended the review.
References
References
