Asthma reviews in primary care which include spirometry lead to improved asthma control in children

Abstract

Introduction: Recent guidelines include spirometry for monitoring children with asthma from 5yrs (NICE, 2017). Objective: To assess the impact of implementing paediatric spirometry into asthma reviews in primary care on asthma control and unscheduled consultations. Methods: Practice nurses (PN) from 10 general practices (GP) in the Midlands, UK were trained to perform and interpret paediatric spirometry, which was used to inform PN led reviews. Children (5-16yr) with GP diagnosed or suspected asthma were invited for review. Asthma control test (ACT) scores and number of unplanned healthcare attendances (UHA) over the previous 6 months were recorded at the baseline review, and 6-months after using postal follow up and review of medical records. UHAs were defined as acute visits to GP or hospital with respiratory symptoms requiring treatment with bronchodilators or oral corticosteroids. Results: 612 children were recruited. By January 2018, follow up ACTs were available from 199 children (32%) and UHA data from 506 children (83%). Overall, mean ACT scores improved from 20.4 to 21.7 (p Mean UHAs did not differ from baseline to follow up in children with normal spirometry; 0.28 to 0.21 per child/6mths, p=0.078. However, in children with obstructed spirometry (FEV1 or FEV1/FVC≤80%) mean UHAs fell from 0.39 to 0.20 per child/6 mths, p=0.014. Conclusion: Childhood asthma reviews in primary care which include spirometry improve asthma control and reduce the number of UHAs. UHAs almost halved in children with obstructed spirometry following review, suggesting a role for providing paediatric spirometry in primary care.