High prevalence of abnormal lung function is seen in children managed for asthma in primary care

Abstract

Introduction: Most children treated for asthma in the UK are managed by primary care practice nurses (PN) where paediatric spirometry is not universally available. It is not known what proportion of these children have abnormal lung function, or how spirometry can impact on decision making. Objectives: To investigate a) the proportion of children managed for asthma in primary care with abnormal lung function, and b) the subjective impact spirometry has on PN decision making. Methods: 7 general practices in Leicestershire, UK were trained to perform and interpret paediatric spirometry. Children (5-16yrs) who were a) diagnosed with asthma or b) undiagnosed but prescribed asthma medications in the past year (possible asthma) were invited for review. Spirometry was attempted in all children. The PN used this data to inform their assessment. After each review, PN were asked if their management would have differed if no spirometry was available. Results: Useable data was obtained in 210/225 (93%) children (table). 16% of reportedly well controlled asthmatics had abnormal lung function. PN reported that availability of spirometry altered their clinical management in 22% of children. Conclusion: Overall, 28% of our cohort had abnormal lung function. Obstructed spirometry was seen in both diagnosed and undiagnosed children in similar proportions. Spirometry altered clinical management in over one fifth of cases. This study supports the usefulness of paediatric spirometry in primary care.