Qualitative insights into planning implementation of FeNO-guided asthma management in primary care
Qualitative insights into planning implementation of FeNO-guided asthma management in primary care
Fractional exhaled nitric oxide (FeNO) testing is used in primary care in some areas of the UK to aid asthma diagnosis but is used less frequently for managing asthma. A randomised controlled trial (RCT) is investigating whether an intervention, including FeNO testing and a clinical algorithm, improves outcomes for patients with asthma. This study was conducted to explore potential for implementation of the intervention. The study aim was to explore views of those with a vested interest in implementing the FeNO intervention into primary care asthma reviews.
In-depth, semi-structured interviews were conducted online with individuals, including those with experience in policymaking, healthcare management, National Health Service commissioning, as healthcare professionals (HCPs) with extended roles, and patients and advocates. Inductive thematic analysis was conducted for nineteen interviews.
Findings suggest complex interplay of barriers, contextual issues and facilitators. Overall, participants perceived FeNO-informed asthma management would enhance care, if used appropriately and flexibly according to context, for example planning implementation alongside remote reviews. Easier, equitable access to funded FeNO equipment would be needed for national implementation. Participants suggested motivation of all involved in future implementation may be increased by guidelines recommending FeNO, and by use of financial incentives and champions sharing best practice examples.
In conclusion, financial obstacles were reiterated as a primary barrier to FeNO use. Despite barriers, facilitating implementation by harnessing prominent cost-benefits could persuade decision makers and clinicians. Findings lay early foundations for development of an implementation strategy.
Lewis, G.
190ea02e-acb2-4cff-a99d-18df28bb1a2e
Morton, K.
9981c3b0-8602-48ea-b9de-58592f5483a1
Santillo, M.
67fe3fd0-9518-45fa-9e06-68d5e56cb811
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Wang, Kay
35ab64db-e4d5-4b4b-9225-54c9bcc6d143
Ainsworth, Ben
b02d78c3-aa8b-462d-a534-31f1bf164f81
Tonkin-Crine, Sarah
453132bf-d8a2-41c5-999d-cb2fcfb45239
December 2025
Lewis, G.
190ea02e-acb2-4cff-a99d-18df28bb1a2e
Morton, K.
9981c3b0-8602-48ea-b9de-58592f5483a1
Santillo, M.
67fe3fd0-9518-45fa-9e06-68d5e56cb811
Yardley, L.
64be42c4-511d-484d-abaa-f8813452a22e
Wang, Kay
35ab64db-e4d5-4b4b-9225-54c9bcc6d143
Ainsworth, Ben
b02d78c3-aa8b-462d-a534-31f1bf164f81
Tonkin-Crine, Sarah
453132bf-d8a2-41c5-999d-cb2fcfb45239
Lewis, G., Morton, K., Santillo, M., Yardley, L., Wang, Kay, Ainsworth, Ben and Tonkin-Crine, Sarah
(2025)
Qualitative insights into planning implementation of FeNO-guided asthma management in primary care.
NPJ primary care respiratory medicine, 35 (1), [16].
(doi:10.1038/s41533-025-00418-w).
Abstract
Fractional exhaled nitric oxide (FeNO) testing is used in primary care in some areas of the UK to aid asthma diagnosis but is used less frequently for managing asthma. A randomised controlled trial (RCT) is investigating whether an intervention, including FeNO testing and a clinical algorithm, improves outcomes for patients with asthma. This study was conducted to explore potential for implementation of the intervention. The study aim was to explore views of those with a vested interest in implementing the FeNO intervention into primary care asthma reviews.
In-depth, semi-structured interviews were conducted online with individuals, including those with experience in policymaking, healthcare management, National Health Service commissioning, as healthcare professionals (HCPs) with extended roles, and patients and advocates. Inductive thematic analysis was conducted for nineteen interviews.
Findings suggest complex interplay of barriers, contextual issues and facilitators. Overall, participants perceived FeNO-informed asthma management would enhance care, if used appropriately and flexibly according to context, for example planning implementation alongside remote reviews. Easier, equitable access to funded FeNO equipment would be needed for national implementation. Participants suggested motivation of all involved in future implementation may be increased by guidelines recommending FeNO, and by use of financial incentives and champions sharing best practice examples.
In conclusion, financial obstacles were reiterated as a primary barrier to FeNO use. Despite barriers, facilitating implementation by harnessing prominent cost-benefits could persuade decision makers and clinicians. Findings lay early foundations for development of an implementation strategy.
Text
100225 clean version with changes post reviewer npjpcrm FeNO implementation
- Accepted Manuscript
Text
s41533-025-00418-w
- Version of Record
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Accepted/In Press date: 5 March 2025
e-pub ahead of print date: 20 March 2025
Published date: December 2025
Identifiers
Local EPrints ID: 499845
URI: http://eprints.soton.ac.uk/id/eprint/499845
ISSN: 2055-1010
PURE UUID: 34385621-bda3-43a2-9c22-08ac77cf1de2
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Date deposited: 07 Apr 2025 16:42
Last modified: 18 Sep 2025 01:43
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Contributors
Author:
G. Lewis
Author:
K. Morton
Author:
M. Santillo
Author:
Kay Wang
Author:
Ben Ainsworth
Author:
Sarah Tonkin-Crine
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