What do patients think about home-based testing for better asthma diagnosis? - Insights from a qualitative study.

BackgroundAsthma is misdiagnosed in one-third of patients. Due to its variable nature, international guidelines recommend performing key diagnostic tests during symptomatic periods or in the morning to improve accuracy. Limited access to timely clinic appointments and community-based diagnostics makes this difficult. Handheld spirometry and fractional exhaled nitric oxide (FeNO) are feasible for home use, enabling timely and flexible testing. ObjectiveTo explored patients views on performing spirometry and FeNO at home during the asthma diagnostic process. DesignA qualitative study using semi-structured interviews. Data were analysed using framework approach. SettingThis prospective observational study was conducted at a National Institute for Health and Care Research Clinical Research Facility (NIHR CRF), based within a large National Health Service (NHS) Trust, as part of the Rapid-Access Diagnostics for Asthma (RADicA) study (ISRCTN11676160). ParticipantsA purposive sample of 15 symptomatic adult patients with GP-suspected asthma who were referred for diagnostic evaluation of the condition; all patients used home spirometry and FeNO devices during their diagnostic processes. ResultsThree themes emerged from the analysis: Perceived value of, and burdens of home testing, Views on device usability and acceptability, and Information and support needs. Home testing was generally welcomed by patients as a way of improving their understanding of their condition and enabling an accurate diagnosis of their symptoms. Key barriers (e.g. testing frequency, lack of privacy) and enablers to improve feasibility (e.g. training and support) were also identified. ConclusionThis study provides valuable insights into the barriers and enablers of home-based diagnostic strategies for asthma. Findings can inform service design and implementation approaches to enhance the feasibility and effectiveness of home testing. FundingThis study was funded by National Institute for Health Research (NIHR) Research for Patient Benefit Grant (NIHR203591) and supported by the Manchester NIHR Biomedical Research Centre (BRC) (grant no. BRC-1215-20007, and NIHR203308), Asthma UK/Innovate (grant no. AUK-PG-2018-406) and North West Lung Centre Charity. The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. Strengths and limitations of this studyO_LIA key strength to this study is that the patients participated in the interviews were representative of those at the diagnostic stage. C_LIO_LIPatients who participated in the interviews openly share their experiences in the absence of the main clinical research staff. C_LIO_LIThe identified enablers and barriers to ambulatory testing using handheld devices for asthma diagnosis are transferable to other settings, including for disease monitoring and self-management. C_LIO_LIThe study findings may not be representative of the experiences and views of all patients with suspected asthma due to the qualitative nature of the study design, but nonetheless, the current study included a diverse group of patients with broad baseline characteristics, providing useful insights into their views. C_LI