Office Spirometry in Primary Care Pediatrics: A Pilot Study

Abstract

ABSTRACT. Objective. The aim of this study was to investigate the validity of office spirometry in primary care pediatric practices.Methods. Ten primary care pediatricians undertook a spirometry training program that was led by 2 pediatric pulmonologists from the Pediatric Department of the University of Padova. After the pediatricians' training, children with asthma or persistent cough underwent a spirometric test in the pediatrician's office and at a pulmonary function (PF) laboratory, in the same day in random order. Both spirometric tests were performed with a portable turbine flow sensor spirometer. We assessed the quality of the spirometric tests and compared a range of PF parameters obtained in the pediatricians' offices and in the PF laboratory according to the Bland and Altman method.Results. A total of 109 children (mean age: 10.4 years; range: 6 -15) were included in the study. Eighty-five (78%) of the spirometric tests that were performed in the pediatricians' offices met all of the acceptability and reproducibility criteria. The 24 unacceptable test results were attributable largely to a slow start and failure to satisfy end-of-test criteria. Only the 85 acceptable spirometric tests were considered for analysis. The agreement between the spirometric tests that were performed in the pediatrician's office and in the PF laboratory was good for the key parameters (forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow between 25% and 75%). The repeatability coefficient was 0.26 L for forced expiratory volume in 1 second (83 of 85 values fall within this range), 0.30 L for forced vital capacity (81 values fall within this range), and 0.58 L/s for forced expiratory flow between 25% and 75% (82 values fall within this range). In 79% of cases, the primary care pediatricians interpreted the spirometric tests correctly.Conclusions. It seems justifiable to perform spirometry in pediatric primary care, but an integrated approach involving both the primary care pediatrician and certified pediatric respiratory medicine centers is recommended because effective training and quality assurance are vital prerequisites for successful spirometry. Pediatrics 2005;116:e792-e797. URL: www.pediatrics.org/cgi/ doi/10.1542/peds.2005-0487; office spirometry, primary care pediatrics, asthma, children.ABBREVIATIONS. PF, pulmonary function; FEV 1 , forced expiratory volume in 1 second; ATS, American Thoracic Society; FVC, forced vital capacity; FET, forced expiratory time; FEF , forced expiratory flow between 25% and 75% of expired FVC; ICC, intraclass correlation coefficient; GP, general practitioner. P ulmonary function (PF) tests are useful in both the diagnosis and the monitoring of lung disease. The international guidelines for asthma management have endorsed the use of objective lung function measures for assigning a severity rating to patients with asthma and guide asthma therapy. 1 Although children's and their parents' reporting of asthma symptoms is important in staging and managing ped...

The Use of Spirometry in a Primary Care Setting

“…Our data suggest that pediatricians utilize spirometry to the greatest extent, and this is likely secondary to the past efforts to teach pediatricians about spirometry, how to utilize spirometry to optimize care of patients with asthma and how to interpret the results. 4,[6][7][8][9][10][11][12] While the usage of spirometry still seems low, our study shows increased frequency of its use over what has been demonstrated previously. This suggests that the NHLBI Guidelines for Management of Asthma have influenced care for patients with asthma.…”

Adverse Health Effects of Child Labor: High Exposure to Chromium and Oxidative DNA Damage in Children Manufacturing Surgical Instruments

“…We attribute the low success of spirometry among the working children to their unfamiliarity with medical examinations, but also to the difficulty of performing spirometry in the field without visual control of the maneuvers. Other researchers have experienced similar difficulties (Zanconato 2005). In adults, poor spirometric performance may reflect poor respiratory health (Ng’Ang’a et al 1992).…”

Electronic Health Record–Based Decision Support to Improve Asthma Care: A Cluster-Randomized Trial

“…1,2 The NAEPP guidelines emphasize the importance of preventive care on the basis of evidence-based principles, including (1) appropriate classification of asthma severity to initiate controller medications for persistent asthma symptoms, 3 (2) monitoring asthma control through repeated symptom assessments, [4][5][6][7] (3) education in conjunction with a written home asthma action/care plan (ACP) that guides self-management for asthma flares, [8][9][10] and (4) the use of primary care office spirometry as a tool for both diagnosis and monitoring asthma control. [11][12][13][14] We used a site-randomized trial design to determine if clinical decision support (CDS) embedded in an electronic health record (EHR) would improve clinician adherence to the NAEPP guidelines in the primary care setting. We hypothesized that this tool would help clinicians increase how often they prescribe controller medications for persistent asthma.…”