Acceptability and feasibility of biomarkers of airway eosinophilic inflammation for the management of preschool wheeze: a qualitative study

Citation

Perikleous A, Lewis G, Bowen S, Pavord ID, Fleming L, Bush A & Griffiths C (2025) Acceptability and feasibility of biomarkers of airway eosinophilic inflammation for the management of preschool wheeze: a qualitative study. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2025-329433

Abstract
Objective: This study aimed to examine whether biomarker tests—finger-prick, skin-prick and offline fractional exhaled nitric oxide (FeNO)—are acceptable and feasible as a guide to treatment decisions, uniquely combining the perspectives of parents of preschool children with wheeze and healthcare professionals (HCPs) working in National Health Service (NHS) primary care. Design: Qualitative interview study. Criterion sampling was used to recruit 16 parents from 16 families, and convenience sampling to recruit 16 HCPs (doctors and nurses) from 14 primary care NHS practices. Qualitative data were collected via online one-to-one interviews and focus groups (FGs), conducted on Microsoft Teams, transcribed and thematically analysed within the NVivo software package. Results: Parents described the biomarker tests as acceptable when they were supported by evidence of effectiveness and empathetic communication from HCPs. Skin-prick testing was the most preferred test by parents as it helped them minimise allergen exposures. HCPs favoured finger-prick and FeNO tidal breathing test due to greater familiarity and feasibility in primary care. Time constraints, cost of devices and training to perform the biomarker tests were reported as barriers to implementation. Both groups agreed that testing frequency should depend on wheeze severity. Finally, a proposed future randomised controlled trial examining whether a biomarker-based approach is superior to the current symptom-based approach was regarded as acceptable and feasible. Conclusion: Finger-prick, skin-prick and FeNO testing are conditionally acceptable and feasible in clinical practice for preschool wheeze. However, there should be evidence of their effectiveness, empathetic communication between parents and HCPs and tests’ cost-effectiveness to support NHS funding.

Journal
Archives of Disease in Childhood