GPs across large parts of the country cannot access a key, NICE-recommended test for diagnosing asthma in children, a charity has warned.

Freedom of information requests revealed that more than half of integrated care boards 59%) do not have enough capacity to provide fractional exhaled nitric oxide (FeNO) for all children that needed it.

Asthma+Lung UK who carried out the research, said variation in access FeNO across the country was particularly concerning given that asthma admissions for children in the most deprived areas are almost twice as high as the least deprived areas.

Of 37 ICBs who responded to questions around commissioning of asthma testing for children, 22 said that FeNO was not available for all of primary care.

Only seven were confident they had the capacity to manage both new diagnostic referrals and existing testing backlogs.

Just five out of the 26 who answered could provide full figures on how many FeNO tests had been done in children in the last financial year. Ten provided partial data.

Two stated they did not have sufficient capacity for new referrals, and two said they had capacity for new referrals only, but not for any backlog.

The charity said it was concerned that children’s asthma services were being sidelined in the face of restructures and budget pressures as well as a shortage of clinical respiratory leads.

Of those that responded, 13 ICBs did not have a dedicated respiratory clinical lead for children and young people, and a further three said they expect existing posts to cease.

A Pulse investigation published in May highlighted that access to local enhanced service funding was a ‘lottery’ with spirometry and FeNO testing highlighted among a variety of issues.

It has also been estimated that neighbourhood respiratory hubs offering primary care diagnostics could save millions of pounds.

Asthma+Lung UK have previously warned that more than half of ICBs do not have enough spirometry testing capacity to meet demand.

Speaking with Pulse, Dr Matt Swallow, a GP and clinical lead at Asthma + Lung UK, said clinicians working in primary care do all they can to keep children with asthma safe and out of hospital but without the tools to provide an accurate diagnosis, they were ‘already on the backfoot’.

He said it was up to ICBs to decide how best to commission services locally, but it seemed most sensible to do it at a PCN or neighbourhood service level.

‘You wouldn’t treat someone for hypertension without doing a blood pressure. We shouldn’t really be in the habit of treating loads of people for asthma without having done simple evidence-based tests that are in the national guidance.’

He said because asthma was not being diagnosed and treated properly, there will be children at school who are avoiding running around and doing activity because their chests feel tight.

‘It’s a very cheap test and if you think how much a GP consultation costs, if someone is having to come back several times with a peak flow diary, or if you have a hospital admission, having access to FeNO testing saves a lot of money.

‘There is an opportunity with neighbourhood working to get this right.’

Sarah Sleet, chief executive at Asthma + Lung UK, said: ‘Huge parts of the NHS in England are in the dark on childhood asthma as many areas either don’t commission enough testing to cover their patch, or don’t commission enough to meet demand.

‘The patchy commissioning of tests is echoed by large geographic differences in the number of kids being rushed to hospital in an asthma emergency.’

An NHS England spokesperson said: ‘The NHS is working to provide better access to tests and clinical assessments for asthma to ensure children in all parts of England can get a diagnosis if they need one.’

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Many GPs cannot access key asthma test for children