{
  "abstract": "Introduction Between 2009 and 2018 the number of deaths related to asthma in Wales increased by 43%. 1 Traditionally, patients referred for asthma diagnosis or review are triaged for a consultant appointment where they undergo a review, followed by a series of diagnostic tests which are ordered before any significant changes are made to the patient’s management plan. We underwent an innovative, collaborative pathway redesign, underpinned by a ‘Physiology first’ approach with the aim of maximising diagnostic outcomes prior to the consultant review, utilising the patients time on the waiting list.Methods The new pathway used a semi standardised testing approach including FeNO, spirometry with reversibility and then if required, a Methacholine Challenge Testing (MCC), whilst maximising the skillset and scope of the workforce available. Initially run as a pilot of twenty-five patients, the collaborative approach was multi-disciplinary and underpinned by a collaborative approach to obtaining diagnostic evidence of asthma.We aimed to measure and compare the two pathways, focusing on the following: i) Average waiting time diagnostic testing ii) Patient compliance with pretest instructions, such as medication withholding iii) Quantifiable outcomes of test results iv) Distribution of physiology staff time.Results The pilot has excellent attendance, with 24/25 (96%) of patients participating in some form of lung function testing and 100% of patients followed the inhaler withholding guidelines. The direct measurables can be seen in table 1:Conclusion The pathway redesign improved average wait time for asthma diagnostic testing completion by 80%, in turn enabling management plan changes to be made at the initial consultant appointments.A proactive approach also improved the patient experience, reduced waiting list burden and increased capacity and planning across both the medical and healthcare science clinics. As a result of the successful measures in this pilot, this approach has now been implemented into the service and is under active review.Reference Value-based prescribing: biological medicines for severe uncontrolled asthma, Sep 2022. Available from: https://awttc.nhs.wales/files/guidelines-and-pils/value-based-prescribing-biological-medicines-for-severe-uncontrolled-asthmapdf/Abstract P21 Table 1A quantifiable breakdown of testing outcomes and average week waits",
  "authors": [
    {
      "affiliations": [
        "Cardiff and Vale UHB, Cardiff, United Kingdom"
      ],
      "name": "Corey Davies"
    },
    {
      "affiliations": [
        "Cardiff and Vale UHB, Cardiff, United Kingdom"
      ],
      "name": "Mrs Lois Attewell"
    }
  ],
  "title": "P21 A ‘physiology first’ approach to lung function testing in difficult asthma patients: a pilot of innovation",
  "uid": "772cd907-169f-553b-9277-6ba72a6cdb9c"
}