Abstract

Diagnosing asthma is challenging and misdiagnosis is common. Paediatric respiratory diagnostics are often unavailable in Primary Care, resulting in children being diagnosed by clinical assessment alone. National guidance advises objective investigations to support diagnosis, and the Quality and Outcomes Framework (QOF), provides incentives to ensure children undergo two objective measures of lung function (one of which being spirometry BDR) to support an asthma diagnosis.
Spirometry BDR and FeNO have limitations and will only give positive results if the child has active disease. Children may wait weeks for investigations during which time they may have commenced inhaled steroid therapy which reduces inflammation, resulting in negative tests. Secondary care clinics perform challenge testing as second line investigations where there is clinical suspicion of asthma, but initial investigation (spirometry BDR, FeNO) is not conclusive.
Limited access to investigations has led to a rise in referrals to secondary care paediatric asthma clinics solely for investigations and diagnosis, meaning that children with more severe disease who require specialist input are waiting longer to be seen.
Leicester Leicestershire and Rutland ICB has established the Leicester Paediatric Asthma Diagnostic Pathway. GPs directly refer children with suspected asthma for spirometry BDR and FeNO testing, with subsequent challenge testing performed on those with negative spirometry and FeNO.
To date, the pathway assessed 148 children. 72 (49%) children had asthma confirmed, 15 (10%) had asthma ruled out and the remainder were unable to undertake testing.
Additionally, referrals into the non-severe asthma clinic reduced from 157 in the 6 months prior to the start of the service to 41 in the 6 months after. Waiting times reduced from 18 to 6 months.
Six children had significant disease at risk of deterioration. They were escalated to a consultant who established treatment within a few days.