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More than half of integrated care systems (ICSs) do not commission enough tests for childhood asthma, information gathered by charity Asthma + Lung UK has shown.
Of 37 ICSs who responded to a survey and subsequent Freedom of Information request by the charity, 22 (59%) ICSs said they did not commission enough fractional exhaled nitric oxide (FeNO) tests to cover their whole ICS footprint.
Guidelines from the National Institute for Health and Care Excellence (NICE) recommend FeNO level is measured in children with a history suggestive of asthma. If this test is not available, or if the test results show FeNO level is not raised, NICE recommends measuring bronchodilator reversibility (BDR) using spirometry.
The lack of commissioning, the charity said, means “children are at risk of missing out on vital treatment, which could keep them safe from asthma exacerbations”.
The information requests also revealed that of the ICSs who responded, 13 did not have a dedicated respiratory clinical lead for children and young people. Three ICSs that do have a post said that they expect existing posts to cease.
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.”
The charity found that areas of greater deprivation saw higher levels of children with asthma being admitted to hospital emergency departments. The rate of children’s emergency asthma admissions in the ICS with the highest concentration of deprivation (Birmingham and Solihull, at 162 per 100,000) was almost double that of the ICS with the lowest concentration of deprivation (Surrey Heartlands, at 84 per 100,000), it said.
The data was gathered by a survey conducted between January and March 2026, and a Freedom of Information request sent in April 2026 to ICSs that had not responded to the survey. The findings form part of the charity’s annual respiratory review.
Darush Attar-Zadeh, a clinical fellow respiratory pharmacist with NHS West and North London integrated care board, said: “As a pharmacist working in children and young people’s asthma, I am deeply concerned by these findings, particularly following NICE’s recommendations in November 2024.
“In north-west London, we have a clinical lead and an asthma network, but 13 responding ICSs reported having no dedicated respiratory clinical lead for children and young people. This raises serious questions about how improvements in care will be driven.
“NICE recommends FeNO, alongside a careful clinical history and other objective tests, when asthma is suspected in children aged five and over. Yet, in April 2026, 59% of responding ICSs still did not commission FeNO testing for children through primary care.
“The stark association between deprivation and emergency admissions is particularly shocking. A child’s asthma outcomes should not depend on where they live.”
Read more: Children and young people with asthma: symptoms, diagnosis and the role of pharmacy
