Asthma diagnosis in school-age children: a survey among Swiss physicians

Background: Clinical guidelines recommend objective tests to diagnose asthma in school-age children, but their availability and use in routine practice remain uncertain. We evaluated asthma diagnostic practices in Switzerland, focusing on first-line tests (spirometry, bronchodilator reversibility testing, and fractional exhaled nitric oxide [FeNO]). Methods: Cross-sectional, nationwide online survey of primary care paediatricians (PCPs) and respiratory specialists. We assessed access to and use of diagnostic tests, focusing on first-line tests, and examined reasons for non-use, referral practices, and guideline consultation. We used multivariable logistic regression to identified factors associated with spirometry access among PCPs. Results: Of 1,055 respondents, 625 diagnosed asthma in children, including 419 PCPs. Among PCPs, 50% (95% confidence interval [CI] 45-55) reported no access to spirometry and 95% (95% CI 92-97) no access to FeNO, whereas all paediatric respiratory specialists and almost all adult respiratory specialists had access to both tests. Barriers to first-line testing among PCPs included economic constraints and difficulties interpreting test results. Spirometry access was lower in French- and Italian-speaking regions than in German-speaking regions (adjusted odds ratio [aOR] 0.09, 95% CI 0.05-0.15), but higher among PCPs working full-time (aOR 2.04, 95% CI 1.11-3.82) and those using Swiss asthma guidelines (aOR 1.71, 95% CI 1.01-2.92). PCPs without spirometry access more frequently referred children to specialists for diagnostic confirmation (89% versus 80%; p=0.019). Conclusion: Many PCPs in Switzerland lack access to guideline-recommended tests. Improving access, reimbursement, and training in test interpretation may help reduce the gap between guidelines and clinical practice.