Abstract

Context:
Current health policy is driving calls to improve early and accurate diagnosis in respiratory disease, but diagnosis of asthma is difficult, particularly in children. Early diagnosis is vital to keep children safe and to support their lung growth over the life course.
The problem:
Asthma is usually diagnosed in primary care but there is significant variance in confidence and competence to do so. Documented challenges around providing objective testing to required diagnostic standards are compounded in children due to inability in completing tests and a lack of competent workforce. Diagnosis is often delayed leaving children at risk of potentially life-threatening asthma attacks.
Strategy for change:
To avoid delays in diagnosis due to challenges with objective testing a toolkit was developed with a clear pathway to support a structured monitored trial of treatment. Supporting resources for HCPs and parents were produced to aid communication and understanding around the process. The roll out of the toolkit was supported with training and guidance for HCPs, a suite of templates to sit within the clinical system and clear advice around clinical coding to improve identification of patient risk factors i.e. Suspected Asthma and Asthma Attack codes.
The toolkit was tested in cohort 1 of Excellence in Asthma for Primary Care Quality Improvement Programme.
Outcomes:

Practice A saw an increase in children on the asthma and suspected asthma register and a decrease in children on inhalers with no diagnosis.
Next steps:
Following testing from cohort one and positive feedback from key stakeholders the toolkit will now be rolled out to all practices.
Messages for others:
Diagnosis of asthma is a process not a one-off event.
Parent education is an essential part of the diagnostic process.