Paediatric asthma diagnosis in Switzerland: A national survey

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Background: Swiss and ERS guidelines recommend lung function tests to avoid misdiagnosis of asthma in school-aged children, but their use in primary care is unclear. Aim: To assess diagnostic practices of childhood asthma among Swiss paediatricians. Methods: In 2024, we conducted a nationwide online survey among members of the Swiss Paediatric Society and the Swiss Society of Paediatric Pulmonology. We assessed availability and use of lung function tests and referrals to specialists. Results: The overall response rate was 42% (936/2255). Of 728 paediatricians caring for children with asthma, 449 (62%) were primary care paediatricians, 40 (5%) paediatric pulmonologists, and 239 (33%) other paediatric specialists or hospital paediatricians. Among primary care paediatricians, 42% used spirometry in >50% of suspected asthma cases, 8% used it in <50% of cases, and 50% never used or lacked access. For FeNO, 4% used it in >50% of cases, 1% in <50% of cases, and 95% never used or lacked access. In contrast, all paediatric pulmonologists had access to both tests and used them in almost all cases of suspected asthma. Reasons for primary care paediatricians lacking or not using spirometry and FeNO included: difficulty in interpreting results, staff shortages and financial reasons, such as lack of insurance reimbursement for FeNO. The most common reason for referral to a specialist was to perform diagnostic tests (85%). Conclusion: Less than half of primary care paediatricians in Switzerland routinely used spirometry or FeNO for asthma diagnosis in school-age children, suggesting that guideline adoption in primary care is suboptimal. Training in test interpretation and better reimbursement may be needed. Funding: SNSF 320030_212519

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