Opinions towards the implementation of spirometry and exhaled nitric oxide testing in children under investigation for asthma in primary care

Abstract

Background: Asthma diagnosis in primary care is usually based on clinical history. This approach often results in misdiagnosis. Recently published UK guidelines recommend objective tests to diagnose and monitor children with asthma but the challenge of incorporating these tests into clinical practice has been recognised. Aim: To explore opinions of primary care staff towards the proposed introduction of spirometry and exhaled nitric oxide (eNO) testing in children. Method: Online survey (prior to testing/recruitment) to primary care staff across 10 practices in Leicestershire (UK) to explore perceptions towards the tests. Sites were indentified to represent inner city and rural areas, different socioeconomic and ethnic groups. A mixture of clinical and administrative staff were asked to participate. The questionnaire included 22 questions asking for perception towards usefulness, acceptability, and barriers to implementation. The survey data was extracted in Excel and analysis conducted using Microsoft Word software. Results: We received 62 valid responses from 25 (40%) doctors, 17 (27%) practice nurses, 11 (18%) healthcare assistants and 9 (15%) non-clinical mangers. Almost half (48%) were positive towards the tests and 43% of clinical staff found diagnosing asthma in children difficult. Most staff (57%) felt practice nurse capacity was a barrier towards implementation, followed by lack of equipment (33%) and training (29%). Conclusion: Primary care staff generally welcome spirometry and eNO testing to improve asthma diagnosis and care in children, but concerns were raised about additional workload, equipment funding and training required.