Respiratory disease screening in school-aged children using portable spirometry

Abstract

Objectives: To assess the prevalence of respiratory disease in schoolaged children and to determine the value of field spirometry.Methods: Data on 313 1st and 4th graders from four public schools in Lisbon were analyzed. A respiratory self-answered questionnaire and standard spirometry were performed. Descriptive and bivariate analysis was followed by multiple logistic regression.Results: Thirty-five percent of the children presented at least one episode of wheezing (18% ≥ 2 episodes), and 4% had asthma. Wheezing was more frequent with family history of atopy (adjusted OR = 2.7; 95%CI 1.4-5.1), maternal smoking during pregnancy, lower respiratory tract infection (LRTI) (adjusted OR = 2.8; 95%CI 1.2-6.2), bronchiolitis (adjusted OR = 3.3; 95%CI 1.3-8.2), and allergy to aeroallergens (adjusted OR = 3.2; 95%CI 1.4-7.2). Asthma was more frequent with previous history of LRTI (adjusted OR = 14.6;) and allergy to aeroallergens (adjusted OR = 8.2; 95%CI 2.0-34.2). Fifty-five percent of spirometry measurements met the acceptability criteria of the American Thoracic Society and of the European Respiratory Society. Wheezers presented mean lower z scores for forced expiratory volume in 1 second (FEV 1 ), ratio between FEV 1 and forced vital capacity (FVC) (FEV 1 /FVC), and forced expiratory flow between 25 and 75% (FEF 25-75 ) (p < 0.05), as well as higher percentage of abnormal FEV 1 , FEV 1 /FVC and FEF , p < 0.05). Conclusions:This pilot study showed a high prevalence of obstructive airway symptoms in school-aged children in Lisbon. Symptoms assessed by the questionnaire showed good correlation with spirometric values. The small prevalence of asthma leads us to speculate that asthma is under-diagnosed in this population.J Pediatr (Rio J). 2011;87(2):123-130: Questionnaire, wheezing, asthma, portable spirometry. ResumoObjetivos: Avaliar a prevalência de doença respiratória em crianças em idade escolar e determinar o valor da espirometria de campo. Métodos:Avaliaram-se 313 alunos do primeiro e quarto ano de quatro escolas de Lisboa. Aplicou-se questionário respiratório autopreenchido, e efetuou-se espirometria. Realizou-se análise descritiva e bivariada seguida de análise de regressão logística múltipla.Resultados: Trinta e cinco por cento das crianças tiveram pelo menos um episódio de sibilância (18% ≥ 2 episódios), e 4% tiveram diagnóstico de asma. Sibilância foi mais frequente com história familiar de atopia (OR ajustado = 2,7, IC95% 1,4-5,1), tabagismo na gravidez, infecção respiratória baixa (IRB) (OR ajustado = 2,8; IC95% 1,2-6,2), bronquiolite (OR ajustado = 3,3; IC95% 1,3-8,2) e alergia a aeroalér-genos (OR ajustado = 3,2; IC95% 1,4-7,2). Asma foi mais frequente com história de IRB (OR ajustado = 14,6; IC95% 1,7-122,9) e alergia a aeroalérgenos (OR ajustado = 8,2; IC95% 2,0-34,2). Cento e sessenta e nove (54%) valores espirométricos preencheram critérios de aceitabilidade. O grupo com sibilância tinha em média valores de escore z inferiores para volume expiratório forçado no primeiro segundo (VEF 1 ), r...

Variation in spirometry parameters in children with and without recurrent respiratory problems

“…A total of 70 children were enrolled in the study; of which 35 cases were in the recurrent RP group and 35 cases in the no-recurrent RP group. The median age of presentation in years in the two groups was 10 [6-13] and 12 [8][9][10][11][12][13] respectively. Male: female ratio in the recurrent RP group was 1.91:1 while in no recurrent RP group it was 1.18:1.…”

“…To the best of our knowledge, this is the first study of its kind conducted in our part of the world. Spirometry has been used in the management of children with bronchial asthma for some time now 12,21,23,25,26 . Several studies have shown that derangements in lung function parameters can also be seen in bronchiolitis obliterans, bronchiectasis (cystic fibrosis-associated or otherwise), hemoglobin disorders like sickle cell disease, etc 14,15,18,27,28 .…”

“…Reference ranges have been devised in several populations to define normality due to these various factors [7][8][9][10][11] . This test has traditionally been used to diagnose obstructive airway diseases like bronchial asthma, but it has been found to be abnormal in many other diseases as well 6,[12][13][14][15][16][17][18] . Spirometry is not difficult to do but it is not a test that is widely used in children 19,20 .…”

Spirometry Abnormalities and Its Associated Factors Among Primary School Children in a Nigerian City

“…The association we found between the presence of respiratory symptoms and abnormal spirometry in children has been previously reported. 6,19,32 This is important because it suggests that the presence of cough precipitated by dust, and wheeze in children should serve as a prompt for screening spirometry to exclude abnormal patterns which could be either obstructive or restrictive. Failure to identify abnormal spirometry pattern in children is a missed opportunity for early intervention to improve both short term and long outcomes.…”

“…This limitation increases morbidity and mortality amongst children, with recognized negative impact on long term outcomes in adulthood. 3,[6][7][8][9][10] Recognition of impaired lung function in childhood may be an opportunity for a potentially effective intervention, such as early referral for specialized care with prompt treatment. 2,[7][8][9] Optimizing lung function in childhood is thus an important public health priority.…”