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Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FENO) in asthma reviews

Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FENO) in asthma reviews
Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FENO) in asthma reviews

Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.

2055-1010
Santillo, Marta
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Ainsworth, Benjamin
b02d78c3-aa8b-462d-a534-31f1bf164f81
Van Velthoven, Michelle H.
5de8c231-3abb-44c3-bc1b-a61f63ee724b
Yardley, Lucy
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Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wang, Kay
d5db72ee-6755-4f79-b8ce-d04e47167927
Tonkin-Crine, Sarah
453132bf-d8a2-41c5-999d-cb2fcfb45239
Santillo, Marta
67fe3fd0-9518-45fa-9e06-68d5e56cb811
Ainsworth, Benjamin
b02d78c3-aa8b-462d-a534-31f1bf164f81
Van Velthoven, Michelle H.
5de8c231-3abb-44c3-bc1b-a61f63ee724b
Yardley, Lucy
64be42c4-511d-484d-abaa-f8813452a22e
Thomas, Mike
997c78e0-3849-4ce8-b1bc-86ebbdee3953
Wang, Kay
d5db72ee-6755-4f79-b8ce-d04e47167927
Tonkin-Crine, Sarah
453132bf-d8a2-41c5-999d-cb2fcfb45239

Santillo, Marta, Ainsworth, Benjamin, Van Velthoven, Michelle H., Yardley, Lucy, Thomas, Mike, Wang, Kay and Tonkin-Crine, Sarah (2022) Qualitative study on perceptions of use of Fractional Exhaled Nitric Oxide (FENO) in asthma reviews. NPJ primary care respiratory medicine, 32 (1), [13]. (doi:10.1038/s41533-022-00272-0).

Record type: Article

Abstract

Current methods to assess asthma and guide inhaled corticosteroid (ICS) dose titration mainly centre on patient-reported symptoms and lung function assessments. However, these methods correlate only weakly with airway inflammation making them unreliable predictors of future exacerbations and ICS requirement. Fractional Exhaled Nitric Oxide (FeNO) is a simple non-invasive objective measure of airways inflammation used predominantly in specialist clinics. Previous qualitative studies have mainly focused on the acceptability of FeNO in secondary care and there is limited insight to support clinicians and patients using FeNO in primary care asthma reviews. This study aimed to explore adult patient with asthma and primary care health care professional (HCP) views on introducing FeNO as part of routine asthma reviews. Twenty-three health care professionals and 22 patients were interviewed over the phone or online. Both groups reported that current asthma reviews are often seen as tick-box exercises and that introducing the FeNO test would make reviews more tailored to the individual patient, rather than relying on subjective patient reports of asthma control. Adults with asthma also highlighted support more open communication and their understanding of asthma, as they desired to feel more engaged in decisions and conversations about their asthma. HCPs reported valuing patient education and empowerment over a paternalistic approach, when time and resources allow. They also recognised FeNO to provide an objective measure of inflammation that could support them in the education and empowerment of patients. FeNO was seen by both groups as a potentially valuable addition to current asthma reviews mainly led by nurses, both for increasing their understanding of current risk of exacerbation and also to provide more tailored and personalised asthma management to patients. Our findings highlighted the need for open and clear communication about how to interpret FeNO results.

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SANTILLO - NPJ PRIMARY CARE RES MEDICINE - Qual study on perceptions of use of FENO
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Accepted/In Press date: 26 January 2022
Published date: 21 March 2022

Identifiers

Local EPrints ID: 454695
URI: http://eprints.soton.ac.uk/id/eprint/454695
ISSN: 2055-1010
PURE UUID: d896ba4b-6175-480d-9d43-f6601fa8d8f8
ORCID for Benjamin Ainsworth: ORCID iD orcid.org/0000-0002-5098-1092
ORCID for Lucy Yardley: ORCID iD orcid.org/0000-0002-3853-883X

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Date deposited: 21 Feb 2022 17:37
Last modified: 28 Apr 2022 06:36

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Contributors

Author: Marta Santillo
Author: Benjamin Ainsworth ORCID iD
Author: Michelle H. Van Velthoven
Author: Lucy Yardley ORCID iD
Author: Mike Thomas
Author: Kay Wang
Author: Sarah Tonkin-Crine

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