Reflection from 12 months of delivery of a Respiratory Diagnostic Hublet (RDH) for children and young people (CYP), in City and Hackney. A review of service level data. (ID 644)
Homerton Healthcare Foundation NHS Trust
Abstract
Introduction
The Adult Cardiorespiratory Responsive Service (ACERS) children and young people (CYP) respiratory diagnostic hublet (RDH) was set up in 2024 for CYP aged 6 to 17 years old. The CYP RDH is located within the Primary Care in City and Hackney and in line with national service specifications. Currently its the only community CYP RDH in Northeast London and tests available are fraction of expired nitric oxide (FeNO) and bronchodilator reversibility (BDR) spirometry. Prior to this, there was no provision for these tests in the community, risking in the CYP population under or over diagnosis of asthma, inadequate medication optimisation and increasing risk of poor outcomes. This review reflects on the results from the first year of the RDH and if access to accurate and quality assured diagnostics leads to improved diagnosis.
Method
A review of the ACERS RDH service level data from April 2024 until March 2025 was analysed, including patient demographics, positive EeNO and BRD spirometry in line with national guidelines, to gain further insight to access requirements, to aid service development.
Results:
The CYP RDH received 321 referrals during the review period, of which 122 have had an initial appointment booked to date, with an attendance rate of 77.04% (n=94). The patient demographics are outlined in table 1. Of the 94 patients who attended, 93.62% (n=88) were able to perform FeNO, and of these 34% (n=32) had a positive result as per guidelines. Of those with a FeNO within normal or intermediate range, 43 (48.86%) went onto perform BDR spirometry with 27.90% (n=12) meeting the 12% change from baseline. 47.6% (n=39) of patients that could or did not complete BDR, however over only 2.12% (n=2) of patients could not perform either test.
Conclusion:
Respiratory diagnostic tests for the CYP population easily performed, resulting in more accurate and quality assured diagnosis. This data shows that if FeNO was widely available in City and Hackney Primary Care, it would help to reduce the demand for BDR spirometry by a third. However, with high demand, capacity needs to be adequate to ensure timely diagnosis, which currently it is not.
Funding: Nil
Conflicts of interest: Laura Graham has received funding to attend the ERS 2024 online from Chiesi.
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