Summary
A survey reported by The BMJ suggests that more than half of England’s integrated care systems lack enough capacity to diagnose childhood asthma in line with current guidelines. The guidelines recommend fractional exhaled nitric oxide testing as the first-line diagnostic test for children with a history of asthma.
More than half of England’s integrated care systems do not have enough capacity to diagnose asthma in children according to current clinical guidelines, a survey reported by The BMJ suggests. The finding points to substantial regional variation in access to the tests used to confirm childhood asthma.
The survey was conducted by the charity Asthma + Lung UK. The report describes a gap between the diagnostic pathway recommended in national guidance and the testing capacity available in many local health systems.
What the survey measured
The survey assessed whether integrated care systems, regional NHS partnerships responsible for planning and coordinating services, had enough capacity to carry out accurate diagnostic testing for childhood asthma. More than half were reported to lack sufficient capacity.
This is a survey of healthcare-service capacity, not a clinical trial or a study of treatment outcomes. The supplied report does not state the survey’s sample size or response rate, and it does not quantify how many children were affected. Its result is therefore best understood as an indication of uneven access to diagnostic services.
Why FeNO testing is important
The 2024 joint guidelines from the National Institute for Health and Care Excellence, the British Thoracic Society and the Scottish Intercollegiate Guidelines Network say that doctors should not diagnose asthma in children from symptoms alone.
For children with a history of asthma, the guidelines recommend measuring fractional exhaled nitric oxide, or FeNO, as the first-line diagnostic test. FeNO is a breath test that measures nitric oxide released from the airways. The guidelines state that asthma should be diagnosed when the FeNO level is 35 parts per billion or higher.
Using an objective test can help place the diagnosis on a measurable finding rather than symptoms alone. When the equipment, trained staff or appointment capacity needed for FeNO testing is not available, clinicians may have difficulty following that recommended pathway. The survey’s regional result means that a child’s access to guideline-based testing may depend partly on where the child lives.
The report presents the capacity problem as a postcode lottery for childhood asthma testing. Improving access to the recommended test would allow more local services to follow the 2024 diagnostic guidance, although the survey itself does not measure whether additional testing would change individual diagnoses or health outcomes.