Spirometry and regular follow‐up do not improve quality of life in children or adolescents with asthma: Cluster randomized controlled trials

Abramson, Michael J.; Schattner, Rosa; Holton, Christine; Simpson, Pamela; Briggs, Nancy; Beilby, Justin; Nelson, Mark; Wood‐Baker, Richard; Thien, Francis; Sulaiman, Nabil; Colle, Eleonora Del; Wolfe, Rory; Crockett, Alan; Massie, John

doi:10.1002/ppul.23096

Cited by 20 publications

(33 citation statements)

References 15 publications

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“…[3][4][5][6][7][8][9] Thus, the diagnosis and subsequent management of COPD appears to be largely based on clinical assessment -despite the frequency of misdiagnosis that occurs. 10 Although a lack of pulmonary function testing has been associated with suboptimal prescribing, smoking cessation and specialist referral, [11][12][13][14][15] studies showing better patient outcomes are lacking. This gap has been used by some physicians to justify not ordering testing.…”

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confidence: 99%

Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Gershon

Mecredy

Croxford

et al. 2016

CMAJ

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BACKGROUND: A small number of people with chronic obstructive pulmonary disease (COPD) receive pulmonary function testing around the time of diagnosis. Because omitting testing increases misdiagnosis, we sought to determine whether health outcomes differed between patients whose COPD was diagnosed with or without pulmonary function testing. METHODS:We conducted a longitudinal population study of patients with physician -diagnosed COPD from 2005 to 2012 using health administrative data from Ontario, Canada. We assessed whether having pulmonary function testing around the time of diagnosis was associated with the composite outcome of admission to hospital for COPD or all-cause death, using adjusted survival analysis.RESULTS: Chronic obstructive pulmonary disease was diagnosed in 68 898 patients during the study period; 41.2% of patients received peridiagnostic pulmonary function testing. In adjusted analysis, patients who underwent testing were less likely to die or be admitted to hospital for COPD (adjusted hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.89-0.94) and were more likely to be prescribed an inhaled long-acting bronchodilator than patients who did not undergo testing. Subgroup analysis suggested that the association of testing and outcomes was confined to patients with COPD diagnosed in the ambulatory care setting (adjusted HR 0.80, 95% CI 0.76-0.84). INTERPRETATION:Confirmation of a COPD diagnosis using pulmonary function testing is associated with a decreased risk of death and admission to hospital for COPD. In ambulatory patients, this effect may be from increased use of appropriate COPD medications. The findings of this study validate current guideline recommendations that encourage pulmonary function testing for diagnosis in all patients with suspected COPD.

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Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Gershon

Mecredy

Croxford

et al. 2016

CMAJ

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“…2 Although practices, rather than individual participants, were randomized in this trial, we introduce the analysis methods as if individuals had been randomized and discuss at the end of the paper how the linear mixed effects model can be extended to incorporate the cluster randomization design. The practices were randomly assigned to one of three groups, and in this paper we focus on two groups: (i) the patients who received spirometry before and after the trial (spirometry group), and (ii) the patients who received usual care that did not include any spirometry (usual care group).…”

Section: Description Of the Data Example And Research Questionsmentioning

confidence: 99%

“…(ii) Does this improvement (change) differ from that of the group which did not receive any spirometry. We selected the physical component summary (PCS) score as our continuous outcome measure, which was derived from the 36-item Short Form questionnaire (see Abramson et al 2 for details). Measurements from 193 individuals were taken at baseline and then at 3, 6, 9 and 12 months follow up.…”

Section: Description Of the Data Example And Research Questionsmentioning

confidence: 99%

“…The model for research question (2). In this section, we compare the change in PCS scores over time between the spirometry and usual care groups.…”

Section: Examplementioning

confidence: 99%

“…For instance, consider forced expiratory volume in 1 s measurements taken from the same persons over years to monitor changes in pulmonary function 1 or quality of life scores assessed every few months for each participant of a randomized controlled trial. 2 Such repeated measures studies (also known as longitudinal studies) collect data on the outcome measure(s) from the same individual at multiple time points and provide the opportunity to gain an understanding of how the outcome measure changes with time in both the individuals and the population. 3 Several factors need to be considered in the statistical analysis of repeated measures data.…”

Section: Introductionmentioning

confidence: 99%

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Models for the analysis of repeated continuous outcome measures in clinical trials

2013

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Repeated continuous outcome measures are common in clinical trials. In this tutorial style paper, using data collected from a trial evaluating an intervention for managing asthma and chronic obstructive pulmonary disease, we demonstrate ways of statistically analysing such data to answer frequently encountered clinical research questions. We illustrate the use of linear mixed effects modelling in doing so and discuss its advantages over several other commonly used approaches. The methods described in this paper can easily be carried out using standard statistical software.

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Does the routine use of spirometry improve clinical outcomes in children?—A systematic review

Boonjindasup

Chang

McElrea

et al. 2022

Pediatric Pulmonology

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Spirometry provides a quantitative measure of lung function and its use is recommended as an adjunct to enhance pediatric respiratory healthcare in many clinical practice guidelines. However, there is limited evidence confirming the benefits (or otherwise) of using spirometry from either clinician or patient perspectives. This systematic review aimed to determine the impact of spirometry on change in clinical decision making and patient-reported outcome measures. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, www. clinicaltrials.gov, and World Health Organization International Clinical Trials RegistryPlatform, from inception to July 2021. We included randomized controlled trials (RCTs) comparing the use versus non-use of spirometry during standard clinical review in children aged <18 years with respiratory problems in clinics. We used Cochrane methodology. The search identified 3475 articles; 8 full-text articles were reviewed but only 1 study fulfilled the inclusion criteria. The single study involved two cluster RCTs of spirometry for children with asthma in general practice. The included study did not find any significant intergroup difference at the 12-month follow-up for asthma-related quality-of-life and clinical endpoints. However, the findings were limited by methodological weaknesses and high risks of bias. With a paucity of data, the clinical benefits of spirometry remain unclear. Thus, there is a clear need for RCTs that provide high-quality evidence to support the routine use of spirometry in children with suspected or known lung disease. Pending the availability of better evidence, we recommend that clinicians adhere to the current clinical practice recommendations.

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Spirometry and regular follow‐up do not improve quality of life in children or adolescents with asthma: Cluster randomized controlled trials

Abstract: The findings do not support more widespread use of spirometry for the management of childhood asthma in general practice, unless it is integrated into a complete management model.

Cited by 20 publications

References 15 publications

Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Outcomes of patients with chronic obstructive pulmonary disease diagnosed with or without pulmonary function testing

Models for the analysis of repeated continuous outcome measures in clinical trials

Does the routine use of spirometry improve clinical outcomes in children?—A systematic review

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