## 5 Discussion  
The aim of this pilot study was to investigate the potential benefits and overall impact of a mobile respiratory function testing service in metropolitan and rural areas of WA. We found that the majority of participants were satisfied with the lung function-testing experience and would recommend the service to others. However, most GPs were not aware of the mobile lung function testing clinic. We found that most participants had poorly controlled asthma indicated by an ACT score \(\leq\)19. Despite this, six respondents who had an ACT score \(\leq\)19 perceived their asthma to be well-controlled. Similar findings were reported in a UK study where only 32.1% of patients with ACT scores \(\leq\)19 considered their asthma was uncontrolled [12]. A finding in this study was that the ACT score did not improve significantly after follow-up, when it was expected participants would have consulted their GP to optimise therapy. Notably eight weeks after the lung function test, some participants had not consulted their GP, which may have been due to a lack of appointment availability. However, given the lack of GP awareness of the mobile lung function testing clinic found in this pilot study, and not knowing when the respiratory physician's report was sent to the GP, there is very little chance that the service can improve disease outcomes. There is evidence that some participants may tolerate symptoms indicative of poor asthma control as part of living with asthma [13]. In a qualitative study in the UK, researchers reported that some study participants had an 'internal barometer', which set 'out of control' asthma symptoms considerably higher than the ACT score. These participants also placed less importance on asthma medications for their current state of health [13]. It should be noted that where participants had consulted their GP and changes were initiated in response to lung function testing, there could be a lag time for achievement of optimum symptom control (for corticosteroids, this can be several weeks). As optimum treatment also requires advice on avoiding triggers, patient education around this is an important component, but for some people, especially those living in rural areas on farms, or those exposed to chemicals at work, this may be challenging. An initial step in optimising treatment for lung disease is to obtain a correct diagnosis and for those with poorly managed lung disease; therapy should be reviewed, and symptoms monitored. Of those with asthma, very few had an Asthma Action Plan, despite most participants experiencing respiratory symptoms in the previous 12 months. Provision of an Asthma Action Plan and individualised asthma education has been shown to reduce asthma severity scores, unscheduled consultations, hospitalisations and asthma-specific quality of life [14; 15]. Furthermore, international guidelines strongly recommend that all patients with asthma receive a written Asthma Action Plan [16]. GPs should be educated on the importance of Asthma Action Plans to empower their patients to achieve better control of asthma symptoms and reduce hospitalisations. Although based on small numbers, some of the disease state characteristics of respondents based on the St George Activity Score and Impacts Score, indicated a significant worsening of symptoms at follow-up. For most participants with COPD, validated test results, such as the CCQ symptom score and CAT score, also showed a greater negative impact of disease at follow-up compared to baseline. This was an unexpected finding that may have been due to seasonal variation. Alternatively, for those with newly diagnosed COPD, perhaps the reality of having this condition influenced their behaviour (i.e., illness anxiety disorder). For many of these participants, it would have been valuable to be able to refer themselves or be referred for lung function testing to obtain an insight into their condition. In the long term, this should lead to optimization of disease management.