{
  "abstract": "Introduction NICE guidelines for asthma diagnosis, monitoring and chronic management were updated in November 2024 (National Institute for Health and Care Excellence, 2024). NICE recommends to start with Fractional Exhaled Nitric Oxide (FeNO) and if elevated (≥35 ppb) asthma can be diagnosed. If FeNO is below 35 ppb or is unavailable, Spirometry with bronchodilator reversibility (BDR) is recommended. A significant BDR is defined as ≥12% increase in FEV 1 or ≥10% increase in predicted FEV1. NICE recommends that patients with normal baseline spirometry should still have BDR. However, concerns have arisen regarding the feasibility of spirometry with BDR following normal spirometry, due to the low number of patients diagnosed with asthma as a result and the increased cost in time and consumables.Methods Audit data was collected from the GP Choose and Book (CAB) service at Alder Hey, Liverpool, since November 2024. FeNO was assessed using a NIOX VERO (NIOX group plc, Oxford) and spirometry was performed using the Vyaire Vyntus ONE (Vyaire Medical, Mettawa, IL, USA).Results 125 (66 male) patients performed FeNO and Spirometry with BDR if indicated. 46 (36.8%) had elevated FeNO. 71 (56.8%) patients had normal FeNO and normal baseline Spirometry. 15 (12%) patients were on medication, which may indicate well controlled asthma. 56 (44.85%) patients had BDR of which 5 (4%) patients had significant reversibility. 8 (6.4%) patients had an obstructive ventilatory defect on baseline, of which 2 (1.6%) patients had significant reversibility. 4 (3.2%) patients with obstruction did not reach reversibility significance, however, their lung function was normal post BDR.Conclusions FeNO is a powerful diagnostic tool with 78% of asthma diagnoses made were due to elevated FeNO. BDR spirometry was performed in 79 patients, of which only 7 patients (8.9%) had significant BDR. Spirometry with BDR has significant resource and environmental implications, such as spacer and bronchodilator usage for each patient and increased appointment length, ultimately reducing the number of patients tested per clinic. Spirometry with BDR may not be feasible considering the low number of diagnoses. An alternative approach could be to only perform BDR when an obstructed pattern is present on baseline spirometry.",
  "authors": [
    {
      "affiliations": [
        "Alder Hey Children’s NHS Trust"
      ],
      "name": "Emma Hesketh"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Trust"
      ],
      "name": "Laurie McCartney"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Trust"
      ],
      "name": "Debbie Large"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Trust"
      ],
      "name": "Nicola Rimmer"
    },
    {
      "affiliations": [
        "Alder Hey Children’s NHS Trust"
      ],
      "name": "Philip Lawrence"
    }
  ],
  "title": "P57 The impact of new NICE guidelines on paediatric asthma diagnosis in a GP choose and book clinic",
  "uid": "59dc29ac-d35b-5487-8be6-77cca6e82933"
}