{
  "abstract": "Introduction Asthma affects over four million people in the UK and patient outcomes remain suboptimal. An objective measure of airway inflammation may provide opportunities for better patient care. An intervention to support the use of fractional exhaled nitric oxide (FeNO) to optimise management in primary care asthma reviews was developed using the Person-Based Approach. The intervention includes an online training package, a web-based FeNO-guided algorithm, which generates management recommendations for clinicians, and a patient information booklet. A randomised-controlled trial of the intervention is expected to finish in late 2025. This study forms part of a nested process evaluation.Aim Explore patient and clinician experiences of the intervention.Methods Patients in the intervention arm and clinicians with a trial role were purposively sampled for in-depth interviews. Separate interview topic guides for clinicians and patients were informed by existing literature and refined during interviews. Audio-recordings were transcribed verbatim and analysed using inductive thematic analysis.Results 27 clinicians participated. Clinicians accepted the FeNO test and intervention components as these could be incorporated into existing reviews. They found patients mostly accepted the test and management changes and clinicians reported seeing patient benefits. Clinicians felt the training and the personalised recommendation from the FeNO-guided management algorithm supported shared decision-making but their judgement remained important in considering patient history, thus being able to override recommendations was important.27 patients participated and were largely accepting of FeNO-testing and management changes, when explained. When reasons for FeNO testing, results or management were not clearly communicated, patients described frustration and uncertainty. Patients highlighted the benefits of FeNO-guided management when their FeNO result was surprisingly high and did not align with their perception of asthma control and when significant changes in management, such as switching from fixed dose regimens to maintenance and reliever therapy, were suggested. Patients liked use of FeNO to monitor changes in inflammation and assess the impact of management changes.Conclusions Patients and clinicians report high levels of intervention acceptability, because the intervention could be incorporated into asthma reviews and most patients could perform the test. When explained clearly by clinicians, FeNO results supported shared management decisions.",
  "authors": [
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "G Lewis"
    },
    {
      "affiliations": [
        "University of Oxford, Oxford, UK"
      ],
      "name": "M Santillo"
    },
    {
      "affiliations": [
        "University of Bristol, Bristol, UK"
      ],
      "name": "L Yardley"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK"
      ],
      "name": "K Wang"
    },
    {
      "affiliations": [
        "University of Southampton, Southampton, UK"
      ],
      "name": "B Ainsworth"
    },
    {
      "affiliations": [
        "University of Oxford, Oxford, UK"
      ],
      "name": "S Tonkin-Crine"
    }
  ],
  "title": "P289 Patient and clinician experiences of a FeNO-guided asthma management intervention in primary care",
  "uid": "336624ec-1c7b-5915-b0ce-e92bbbdbc174"
}