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

Background: Asthma 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. Objective: To explored patients' views on performing spirometry and FeNO at home during the asthma diagnostic process. Design: A qualitative study using semi-structured interviews. Data were analysed using framework approach. Setting: This 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 ). Participants: A 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. Results: Three 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. Conclusion: This 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.