An audit of the Concordance of the Peel Group Practise to British Thoracic Society / Scottish Intercollegiate Guidelines Network and The National Institute for Health and Care Excellence guidelines on the Investigation and diagnosis of Asthma in Chil

Problem

Introduction: Asthma is a major cause of morbidity and mortality in children and adults. It can be difficult to diagnose , the diagnostic investigations lack sensitivity or specificity. To aid in the diagnosis and management of asthma two conflicting guidelines have been produced from the British Thoracic Society (BTS) / Scottish Intercollegiate Guidelines Network (SIGN) and the National Institute for Health and Care Excellence.

Approach

Objective 1: To audit the Peel group practise on diagnosis of asthma in Children specifically if children are being referred for spirometry. This data was reviewed to asses’ concordance with the NICE and then subsequently the BTS/SIGN Guidelines. Objective 2: Review the literature with regards to the conflict between the two guidelines.Methods: Patients diagnosed with Asthma between the ages of 1-8 were identified on the practise database. There notes were then reviewed to asses concordance with both guidelines. A PubMed search to review the literature around the guidelines.

Findings

Results: The practice does not follow NICE guidelines but is partly concordant with SIGN/BTS guidelines. As per the guidelines the practise diagnoses on clinical features but does not arranged spirometry for medium and low risk patients.

Consequences

Recommendations: 1. High to intermediate risk patients should be coded with ‘suspected asthma’. There should then be annual audits to look for patients with this code who had reached the age of five and then arrange to review them and refer for spirometry if clinically appropriate.2. If the patients are classified as Low risk an alternative diagnosis should be investigated before referring for investigations like spirometry. Conclusion: The lack of concordance is likely due to the practise being unaware of the guidelines. It may also be due to the technical and practical limitations of spirometry in young children. This has resulted into evidence not being translated into clinical practise. Further clarity must be provided by the future combined BTS/SIGN NICE guidelines. But these guidelines must reflect the realities of day to day general practise in the UK.