Asthma: diagnosis, monitoring and chronic asthma management (BTS, NICE, SIGN)

Identify children who may have undiagnosed asthma for review using the asthma case-finding search ASTCF00, which identifies children aged 5 to 17 with no known diagnosis of asthma with: 

Conduct a clinical review, which may be face to face or telephone, to consider the likelihood of asthma (based on a suggestive history, family history and triggers) and arrange appropriate objective diagnostic testing if asthma is suspected. This should involve NICE-compliant diagnostic testing, including FeNO, spirometry with reversibility, peak flow variability, skin prick testing, or total IgE plus eosinophils (see the BTS, NICE and SIGN guideline on asthma). Spirometry, FeNO and skin prick testing will soon be available at the Children's Respiratory Diagnostic Hub (CDC) or another appropriate local service (for example, practice-based phlebotomy). 

Peak expiratory flow rate (PEFR) reversibility is an option if FeNO or spirometry are not available or delayed (measure PEFR twice daily for 2 weeks. Diagnose asthma if PEFR variability [expressed as amplitude percentage mean] is 20% or more). 

Post-diagnostic testing review: if the diagnosis of asthma is confirmed, record the basis for this in the person's medical records, alongside the coded diagnostic entry, and undertake an asthma annual review including the provision of a personalised asthma action plan.

Identify those with high risk for asthma review using the AST00 search, which identifies asthmatic children aged 5 to 17 with:  

Our initial searches identify approximately 950 Brent patients in this category. 

Provide each child with an extended 30-minute face-to-face consultation with a GP, pharmacist or nurse to ensure a comprehensive asthma assessment. 

Review to ensure child is on updated NICE guidelines for treatment.

Review inhaler technique face to face (this cannot be done through video or by sending an inhaler technique video link). 

Assess the smoking status of child and parents, provide information and promote smoking cessation by signposting to Stop Smoking London for support and resources. Referral to Brent smoking cessation team is available for eligible families (for example, shisha smoking, known mental health difficulties or pregnancy). 

Enquire about the presence of mould in the home. If mould is reported, refer to a Social Prescribing Link Worker (SPLW) for further support or to Brent Health Matters and Brent housing team. Resources for support here include the Royal College of Paediatrics and Child health (RCPCH) template for housing, green doctors, London mould and damp checklist. 

Referral to Brent Community Asthma Nurse as necessary for any children and families who require further support, who may be underserved, who may need more support and education around asthma, who may have safeguarding concerns impacting asthma management or to prevent unnecessary re-attendance at A&E or urgent treatment centre. 

Referral to secondary care as appropriate to prevent unplanned hospital admission. 

Provide a Healthy Child signposting leaflet to each family. The leaflet will be supplied by the Borough team to ensure accessibility. 

After clinical assessment, provide the child or carer with a written personalised asthma action plan (PAAP), detailing asthma control, modifiable risk factors for poor outcomes and optimise management strategies. 

If asthma control is suboptimal or any medication changes are made, then please follow-up the patient within 8 to 12 weeks as per usual NICE guidelines.  

The service will work in collaboration with Child Health Hubs to ensure a seamless pathway if children and young people need to be referred into a preventative service or further specialist review for their care. 

Work cooperatively and constructively with partners, particularly regarding vulnerable clients to ensure effective communication processes are in place. 

Provision of educational resources material and written/SMS safety netting advice to parents. 

Face-to-face (or video) inhaler technique checks with mandated face-to-face training attendance (this will be the children and young people tier 3 asthma course plus adult inhaler teaching). 

Maintenance and reliever therapy (MART) initiation for any new asthma diagnosis over 12 years. 

Rising risk chronic obstructive pulmonary disease reviews. 

A focus on identification and diagnosis of suspected asthma. 

Enhanced reviews for high-risk asthmatic children. 

Lower review thresholds than the NWL specification to ensure a broader reach. 

High-risk criteria as outlined. 

30-minute, mandated face-to-face appointments. 

Smoking status check (both children and young people and household contacts) with stop smoking referral. 

Focus on inequalities with active questioning on housing and mould with clear signposting pathways within the borough for support, including to the Brent Health Matters team. 

Referral to our local asthma nurse if indicated. Brent has been trying to encourage more referrals in the local asthma nurse is underutilised. 

Brent Healthy Child leaflet linking families to wider health and social care support and increasing health literacy and engagement. 

Children or adolescents aged 5 to 17 years of age who have been identified as possibly having undiagnosed asthma based on the case-finding search ASTCF00 as outlined.  

Children or adolescents aged 5 to 17 with a diagnosis of asthma and identified as having high-risk asthma based on the AST00 search as outlined.  

Access to soft or hard copies of asthma management plans. 

Access to soft or hard copies of brent health child leaflet. 

The Willesden CDC will have access to FeNO, spirometry, eosinophil, and reversibility testing. 

Placebo inhalers for inhaler technique demonstration.