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GPs find spirometry testing 'useful' for asthma reviews in children, study finds

Using spirometry as a diagnostic test for asthma in children is ‘acceptable’ to patients and ‘helpful’ for making the clinical diagnosis of asthma, a study has found.

Results from the Champions Study, conducted by researchers from the universities of Leicester and Oxford, were presented at the RCGP conference in October.

Although this research is not part of the NICE feasibility pilot for its new asthma guideline - due for publication this week - one of the authors, Dr Erol Gaillard, is a member of NICE's asthma guideline development group.

During the Champions Study, spirometry and forced exhaled nitric oxide (FeNO) training was provided in 10 pilot clinics across GP practices in Leicestershire and Northamptonshire and both tests were attempted on all children attending the clinics.

Preliminary analysis found that just under 100% of parents and carers said that they would be extremely likely or likely to recommend spirometry and 87% of children said that they would be happy to have the test again.

The research also found that clinical staff found the spirometry information useful in supporting or directing clinical management plans in 92% of patient reviews.

Useable spirometry data was collected in 92% of children aged 5-11 and 96% of children aged 12-16, but the data on FeNO testing was still under analysis at the time of presentation at the conference.

The poster said: ‘The preliminary data suggests that providing spirometry in general practice gives useable data, is acceptable to children and their parents and furthermore, clinical staff find the tests helpful in supporting asthma reviews.’

NICE plans for GPs to carry out spirometry and FeNO testing were met with uproar from GP experts in 2015, with the BMA and RCGP warning that the tests were too complex and expensive to be carried out in primary care.

NICE subsequently took the unprecedented step of delaying the publication of the guidelines and agreeing to commission pilot studies to assess the feasibility of doing the tests in primary care. 

The row over NICE's delayed asthma guideline

According to NICE, new guidelines on diagnosis and monitoring of asthma were needed because ‘there is evidence that incorrect diagnosis is a significant problem’.

The draft guidelines, released in January 2015, bypassed the option to carry out a trial of therapy as means to diagnose asthma – currently advised by the gold-standard SIGN/BTS guidelines on diagnosis – and were to see GPs required to get extra tests to confirm a diagnosis.

But the BMA’s official response to the draft guidelines warned that it was a mistake to go against the BTS/SIGN guidance, and said NICE should adopt the recommendations from these gold-standard guidelines.

The RCGP warned that NICE’s recommendations would lead to increased GP appointments and referrals, and increased costs for practices.

Earlier this year, NICE opened up its planned guidelines on asthma diagnosis for a second consultation, after GPs piloting the newly recommended algorithm found the tests involved were expensive, time consuming and did not necessarily improve the accuracy of diagnosis.

Readers' comments (6)

  • Cobblers

    Bearing in mind that spirometry involves an expensive bit of kit requiring a nurse or doctor to use and peak flow meter is cheap and can be used at home, in what way are the spirometry readings superior to a PEFR in asthma?

    I have read this article and also the thorax bmj article and both gloss over this point.

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  • FeNO testing is definitely more useful in diagnosis of asthma in children than spirometry.

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  • 92% 5-11 year olds.......really?? Would like to see the breakdown for each age in that group. Most 5 year olds struggle to give a decent PF, never mind spirometry. What do we do with the 5 year olds who cannot/will not perform a meaningful spiro? Surely clinical judgement should trump a flawed test in this group.

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  • Knowledge is Porridge

    If this looks promising, please roll out across Leicester and Northants before nationwide. Does it scale? Does it cost? Is it really useful outside a study setting?

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  • Vinci Ho

    Mmmmm
    You just feel like the design is very deliberate in terms of trying to win back the narrative of the way we should diagnose asthma in children particularly. It could easily just compared two cohorts of patients diagnosed using either NICE or BTS/SIGN pathway and examining the accuracy of the diagnosis later.
    Instead , the design looked like the drug reps coming to our surgeries and give free samples of a drug , then ask you whether it is a good one or not.
    Sometimes you wonder whether the stresses of being a ‘nice guy’ in office had inevitably amplified his/her human flaws.
    Please come back to reality .......

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  • Vinci Ho

    "The criterion of the scientific status of a theory is its falsifiability, or refutability, or testability."
    —Karl  Popper
    ‘’The first principal is that you must not fool yourself- and you are the easiest person to fool.’’
    Richard Feyman

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