Abstract

Aims / Objectives Background:
Asthma remains a significant health burden in the UK, with high morbidity and
preventable mortality. Current by BTS / SIGN / NICE NG245 guidelines recommend
FeNO as a first-line diagnostic test in children, however in Northern Ireland access is
limited to central hubs, leading to delays. This project aimed to improve access to
FeNO in primary care, increase uptake, and support more accurate diagnosis.

Methods:
A QI project using three sequential PDSA cycles over three months at a single GP
practice. We identified eligible patients (children aged 6-11 with confirmed or
suspected asthma) via EMIS, establishing a baseline FeNO testing rate of 0%.
Interventions comprised a staff education session, targeted patient SMS recall via
AccuRx, and placement of educational posters throughout the practice. The primary
outcome measure was the proportion of eligible patients undergoing FeNO testing.

Relevance / Impact:
FeNO testing is recommended as the first line diagnostic test by BTS / SIGN / NICE
NG245 yet uptake in primary care remains inconsistent. This project demonstrates
that point-of-care FeNO testing is feasible within a GP practice without disrupting
existing workflows, offering a replicable model for practices seeking to align with
current guidance.

Outcomes / Discussions:
FeNO uptake rose from 0% to 22% in three months, exceeding the SMART
objective. SMS recall was the most effective intervention (167% of predicted uptake);
educational posters outperformed expectations at 230%. Staff education alone was
less effective. Patient demand following SMS outreach exceeded clinic capacity,
underscoring the need to plan service infrastructure alongside engagement. The
project prompted discussion regarding permanent FeNO provision at the practice.