The CNS and physiology team were available on the telephone to help with patient queries during working hours. Exhaled nitric oxide, blood tests or skin prick testing was only performed if patients were reviewed face-to-face. If spirometry was obstructive, the patient was asked to repeat spirometry after taking 400 µg salbutamol to assess bronchodilator responsiveness. Patients were asked to perform spirometry 24 hours prior to their clinic appointment or if symptomatic. The DA CNS undertook preclinic telephone consultations to identify patients who would benefit from face-to-face reviews. The total number of FEV 1 measurements, FEV 1 reductions >20% and new actions taken (defined as: reviewing face-to-face, sending to general practitioner or emergency department for review, initiating steroid or antibiotic courses, dispatching electronic monitoring devices inhalers and planning to initiate directly observed therapy once school resumed) were logged from patient records. Patients were required to have at least one home measurement to be eligible for inclusion. The physiologists gave usage instructions, taught and checked technique with video calls for troubleshooting, and validated results (ATS/ERS (American Thoracic Society/European Respiratory Society) criteria).įorced expiratory volume in 1 s (FEV 1) and forced vital capacity were collected on patients with home spirometers from 7 April to 31 October 2020. Home spirometers were dispatched from 7 April 2020. The number of unscheduled hospital admissions, steroid courses in the previous year, whether on a biological and family and patient willingness to perform home spirometry, influenced selection. Patients aged 5 years or older who had previously reliably performed spirometry were issued home spirometers (NuvoAir, Stockholm, Sweden), based on clinical need. We aimed to answer the following questions: (1) Can children with DA who had previously performed spirometry reliably perform home spirometry and can they be monitored and managed remotely? (2) Would the rate of failed appointment attendance reduce when virtual consultations replaced face-to-face consultations? We describe our experience and the impact on service delivery and asthma control in a subset of patients who were monitored with home spirometry. We switched to video consultations using the National Health Service (NHS) Attend Anywhere platform in June 2020. We introduced home spirometry, clinical nurse specialist (CNS) telephone triage prior to appointments, and virtual multidisciplinary team (MDT) clinics and meetings. We therefore explored new approaches to deliver our difficult asthma (DA) service. 1 2 Due to the pandemic, outpatient face-to-face consultations were suddenly reduced and the majority changed to telephone consultations. Prior to the COVID-19 pandemic, few studies had investigated the effectiveness of virtual asthma clinics for children. In our DA cohort, we demonstrate better attendance rates at virtual multidisciplinary team consultations and reduced hospital admission rates when augmented with home spirometry monitoring. There was DA clinic cancellation/non-attendance (16% vs 43% p20% decrease in forced expiratory volume in 1 s, resulting in new action plans in 87% of these episodes. From March to August 2020, 110 patients with DA (68% virtually) were seen in clinic, compared with March–August 2019 when 88 patients were seen face-to-face. We rapidly switched to virtual clinics and rolled out home spirometry based on clinical need. The COVID-19 pandemic necessitated an urgent reconfiguration of our difficult asthma (DA) service.
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