Children in half of England could be missing out on an asthma diagnosis, leaving them at increased risk of serious asthma attacks and emergency hospital admissions, according to lung health charity Asthma + Lung UK.
New research by the charity published today [16 September] reveals that the majority of Integrated Care Systems (ICSs) in England are failing to commission asthma testing for children and young people in primary care to sufficiently cover their areas.1
The charity is highlighting system-wide issues with asthma care for children and young people. They are calling for equal access to testing across all ICSs, to ensure all children with asthma, no matter their postcode, get a fast, accurate diagnosis and access to the treatment they need as quickly as possible.
Asthma + Lung UK’s Respiratory Review, now in its second year, reveals a worrying picture for the lung health of children and young people, with access to accurate tests to diagnose asthma varying significantly depending on where they live. The charity is concerned that the results of their review suggest children’s asthma services are being sidelined in the face of restructures and budget pressures.
Of the ICSs that responded to Asthma + Lung UK’s survey or Freedom of Information request, over half (59%) did not commission the recommended first line test for childhood asthma to sufficiently cover their area, failing to meet the standards set out in the National Institute for health and Care Excellence Asthma Guideline.1,2 As a result, the charity says children are at risk of missing out on vital treatment, which could keep them safe from asthma exacerbations.
Asthma is one of the most common chronic childhood conditions, affecting nearly 1 in 10 children.3 Tragically, one child dies of asthma every four weeks, with those from the most deprived communities four times more likely to die of asthma than those from the least deprived.4
Asthma + Lung UK research also points to significant geographic differences in the proportion of children being admitted to hospital in an asthma emergency, with a strong link between deprivation and higher admissions. The charity’s analysis shows that the rate of children’s emergency asthma admissions in the ICS with the highest concentration of deprivation is nearly double that of the ICS with the lowest concentration of deprivation.5
The NICE Asthma Guideline recommends Fractional Exhaled Nitric Oxide (FeNO) as a first line test for asthma in children. Asthma + Lung UK issued surveys and Freedom of information requests to all of England's 42 ICS areas, asking questions about whether they commissioned enough FeNO to cover their geography and whether it was enough to meet demand.
The Asthma + Lung UK Respiratory Review also found:
- Only five out of the 26 ICSs who answered a question about FeNO test numbers were able to tell us how many had been performed in their area for children in the last financial year. 10 held only partial data, 11 said data was not available. (16 ICSs did not respond to the question).6
- Just 15 ICSs who responded to the survey reported they were commissioning the recommended testing in primary care for children and young people. Only seven of the 15 services were confident they had the capacity to manage both new diagnostic referrals and existing testing backlogs.7(For the remaining eight ICSs who are commissioning testing, two stated they did not have sufficient capacity for new referrals, two ICSs said they had capacity for new referrals only, but not any backlog. Two ICSs responded to say that data to assess capacity was unavailable. Two ICSs did not respond to the question about capacity.)
Asthma + Lung UK is also concerned that a lack of focused respiratory leadership may be contributing to the issue. Its research found that 13 ICSs who responded don’t have a dedicated respiratory clinical lead for children and young people, and a further three ICS said they expect existing posts to cease.8 The true figure without a dedicated children’s respiratory lead could be much higher, as ICSs across England continued to restructure after the end of the survey window.9
With ICSs facing tough financial choices, the charity suggests a lack of national emphasis on respiratory disease means that ICSs are not prioritising children’s asthma care. In response, the charity is calling for a national plan, known as a Modern Service Framework (MSF) that specifically focuses on respiratory care. Such a plan could set minimum expectations for diagnosis and mean that all ICSs in England would be expected to prioritise children’s asthma diagnosis and care.
Dr Matt Swallow, Clinical Lead at Asthma + Lung UK and a practising GP, said: “A child’s access to timely and accurate asthma diagnosis should not depend on where they live. Too many children already face avoidable disadvantages to their lung health, from poor-quality housing to high levels of air pollution. These are often factors beyond their families’ control. The fact that some children must also contend with long waits or limited access to diagnostic testing simply because of their postcode is unacceptable.”
“On the frontline in primary care, we do all we can to keep children with asthma safe and out of hospital; but without the tools to provide an accurate diagnosis, we are already on the backfoot. With the right diagnosis, treatment and support, asthma should be manageable and have a minimal effect on a child’s life. But without sufficient diagnostic capacity, many children risk being missed altogether, leaving them vulnerable to serious asthma attacks, avoidable emergency hospital visits and unnecessary distress for both them and their families.”
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. Those differences are not random – there is a close link between deprivation and poor lung health, with more deprived ICSs seeing higher rates of children’s asthma emergency admissions.
“Our Respiratory Review gives us a clear picture of the unacceptable state of children’s respiratory care across the nation, showing that when it comes to lung health people are being failed from childhood.
“Without urgent action on children’s asthma care, the government’s own ambition to create the healthiest generation is at risk. Ministers should introduce a plan to prioritise respiratory care for children and young people in England, as part of a Modern Service Framework to implement good respiratory care across the country. More timely and accurate diagnosis will help children miss fewer school days, reduce the risk of asthma exacerbations, emergency admission and preventable deaths.”10
-ENDS-
Asthma + Lung UK Respiratory Review survey methodology
The Respiratory Review presents key metrics from publicly available data for all ICSs in England, combined with information provided by ICSs through a survey and Freedom of Information request.
A survey was sent to all 42 ICSs and conducted between January and March 2026. In April 2026, Asthma + Lung UK sent a Freedom of Information request to ICSs who had not completed the survey. This consisted of a subset of survey questions. Where ICSs had merged, we asked for data on the former ICS footprint.
We received 38 responses in total (19 ICSs answered our original survey and 19 ICSs responded to our Freedom of Information request). 37 ICSs responded to the specific question about whether they commissioned FeNO testing for children.
Data from the Asthma + Lung UK Respiratory Review is available on request.
References
1. 59% of ICSs who responded to Asthma + Lung UK’s survey question reported that they did not commission FeNO testing in primary care for children to the extent that the whole ICS footprint is covered (22/37 ICSs). Five ICS did not respond.
2. The NICE/BTS/SIGN Asthma guidelines recommend that children should be diagnosed with Fractional Exhaled Nitric Oxide (FeNO) as the first line test, with spirometry as the second line test.
3. Over 1 million children in England are living with asthma, Calculated from Health Survey for England 2018.
4. Death rate was four times higher for children living in the most deprived neighbourhoods of England (2.66 per 1 million children) compared to the least deprived (0.68 per 1 million children)Child deaths due to Asthma or Anaphylaxis, National Child Mortality Database Programme Thematic Report, Data from April 2019 to March 2023.
5. For asthma emergency admissions among children, the rate in the ICS with the highest concentration of deprivation (Birmingham and Solihull) is 93% higher, or 1.9 times, than the rate seen in the ICS with the lowest concentration of deprivation(Surrey Heartlands). For respiratory emergency admissions, the rate is 72% higher.
Children + young people: respiratory emergency admissions, asthma emergency admissions, deprivation, and Fractional Exhaled Nitric Oxide (FeNO) testing https://www.datawrapper.de/_/wtUwz/?v=23
6, 7. Children + young people: respiratory emergency admissions, asthma emergency admissions, deprivation, and Fractional Exhaled Nitric Oxide (FeNO) testing https://www.datawrapper.de/_/wtUwz/?v=23
8. 25/38 ICSs reported having a CYP respiratory clinical lead, reduced to 22/38 as three ICS advised that their CYP respiratory clinical role was ceasing
10. Children and young people’s asthma diagnosis – the role of FeNO testing and the case for change – Taskforce for Lung Health.