6754 ‘Dear colleague, please perform spirometry/FeNO tests to confirm the diagnosis of asthma’

Objectives The NICE guidelines recommend objective tests for diagnosis of asthma in children.1 The primary care Quality and Outcomes Framework (QOF) has resulted in children being referred to hospitals for asthma diagnostic tests.2 The project aimed to assess the adherence to NICE guidelines, the utilisation of diagnostic methods and their impact on medication changes. Methods A prospective/retrospective multi-centre quality improvement (QI) project was conducted, involving paediatric patients aged 5–16 years referred for asthma diagnosis. Data was collected anonymously from seven hospitals within the West Midlands Paediatric Asthma Network from September 2022 to September 2023. The Forced Expiratory Volume in 1 sec (FEV1), Forced Vital Capacity (FVC), Fractional Exhaled Nitric Oxide (FeNO), Bronchodilator Reversibility (BDR), Asthma Control Test (ACT), patient demographics and medication changes were analysed. Results Among 111 children referred for spirometry, 97/111 (87.8%) underwent spirometry, but only 19/97 (19.5%) had BDR testing. The most common reason for not completing spirometry was the child's inability (8/14, 57.1%). Despite presenting with symptoms, a significant proportion of children had normal spirometry results, both with a history of cough and wheeze (53/55, 96.3%) and wheeze on examination (5/6, 83.3%). FeNO testing was performed in 56/111 (50.4%) of cases, with 36/56 (64.2%) showing normal results. 21/34 (61.7%) in the cough and wheeze group and 2/4 (50%) in the wheeze on examination group had normal FeNO (Conclusion Paediatric asthma diagnosis remains primarily clinical, with objective tests such as spirometry and FeNO having limited impact on altering diagnosis or management.3 The study suggests that if these tests are conducted, they should be performed when the child is highly symptomatic. Consequently, the allocation of time and resources for objective tests should be carefully considered when clinical history strongly suggests asthma. This study underscores the importance of re-evaluating the timing and need for a different diagnostic approach in confirming the diagnosis of paediatric asthma. References Asthma: diagnosis, monitoring and chronic asthma management, NICE guideline, 22 March 2021. Quality and Outcomes Framework guidance for 2021/22. Clare Murray, et al. Diagnosis of asthma in symptomatic children based on measures of lung function: an analysis of data from a population-based birth cohort study, October 2017.