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Original research
Effectiveness of paediatric asthma hubs: a clinical pilot study
  1. Ali Hakizimana1,2,
  2. David K H Lo1,2,
  3. Damian Roland3,4,
  4. Vinayak K Rai2,
  5. Lesley Danvers2,
  6. Rachel Rowlands3,
  7. Molla Imaduddin Ahmed2,
  8. Reeta Herzallah2,
  9. Erol A Gaillard1,2
  1. 1Department of Respiratory Sciences, Leicester NIHR Biomedical Research Centre (Respiratory Theme), University of Leicester, Leicester, UK
  2. 2Department of Paediatric Respiratory Medicine, Leicester Children’s Hospital, University Hospitals of Leicester NHS Trust, Leicester, UK
  3. 3Paediatric Emergency Medicine Leicester Academic (PEMLA) Group, Children’s Emergency Department, Leicester Royal Infirmary, Leicester, UK
  4. 4SAPPHIRE Group, Health Sciences, University of Leicester, Leicester, UK
  1. Correspondence to Dr Erol A Gaillard; eag15{at}leicester.ac.uk

Abstract

Background Children and young people (CYP) with asthma in the UK are at higher risk of poor outcomes compared with other high-income European countries due to factors including poor access to high-quality asthma reviews, diagnostic testing and inconsistent postattack reviews. The Leicester Integrated Care Board funded the first UK pilot asthma hub for CYP, to investigate the feasibility and effectiveness of hubs, in providing postattack reviews along with providing asthma education, the opportunity to carry out diagnostic lung function tests and optimise treatment.

Methods Clinical pilot study including CYP aged 4–17 years referred to the hub with uncontrolled asthma or postattack from November 2021 to April 2022. CYP received a structured clinical assessment including National Institute for Health and Care Excellence (NICE) first-line diagnostic investigations for asthma including spirometry, bronchodilator reversibility (BDR) and fraction of exhaled nitric oxide (FeNO).

Results Of 312 CYP referred (mean age 8.6±3.2 years; 42% women), 266 (85.3%) attended their appointment. Median time from referral to review was 2 days (IQR 1–3). Three CYP (1.1%) were severely unwell at review and required further hospital treatment. In the 231 CYP who completed first-line tests, asthma was confirmed for 73 (31.6%) based on NICE diagnostic criteria for CYP. Twenty-two per cent of children with normal baseline spirometry had ≥12% BDR.

Conclusion Paediatric asthma hubs are a feasible model of care to deliver CYP postasthma attack reviews and identify high-risk patients requiring further treatment. Spirometry, BDR and FeNO testing allowed diagnostic confirmation in a significant proportion of CYP.

  • Respiratory Medicine
  • Paediatrics
  • Primary Health Care
  • Paediatric Emergency Medicine

Data availability statement

All data relevant to the study are included in the article or uploaded as supplementary information.

https://doi.org/10.1136/archdischild-2023-326635

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    Data availability statement

    All data relevant to the study are included in the article or uploaded as supplementary information.

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    Footnotes

    • X @damian_roland

    • Contributors EAG and DKHL designed the study and contributed to data collection and data analysis. VKR, LD, RH collected data. MIA, DR, RR contributed to study delivery. AH wrote the first draft of the manuscript and all authors contributed to the revision and approved the final version of the manuscript. EAG is the guarantor for the manuscript.

    • Funding This study was funded by the Leicester, Leicestershire and Rutland Integrated Care Board.

    • Competing interests EAG: none relating to this manuscript. Unrelated to this manuscript, consultancy work for Boehringer Ingelheim with money paid to the institution (University of Leicester). Investigator led research grants from Circassia Group, Gilead Sciences, Chiesi Limited and Propeller Health. Research collaboration with AstraZeneca, Helicon Health and Adherium (NZ) Limited. Speaker fees Circassia Group and Sanofi. MIA: Children’s and Young people clinical lead at Leicester, Leicestershire and Rutland Integrated Care Board. National Webinar for Proveca Limited.

    • Provenance and peer review Not commissioned; externally peer-reviewed.