Clinically Useful Spirometry in Preschool-Aged Children: Evaluation of the 2007 American Thoracic Society Guidelines

Abstract

Rationale. In 2007 the American Thoracic Society (ATS) recommended guidelines for acceptability and repeatability for assessing spirometry in preschool children. The authors aim to determine the feasibility of spirometry among children in this age group performing spirometry for the first time in a busy clinical practice. Methods. First-time spirometry for children age 4 to 5 years old was selected from the Children's Hospital Boston Pulmonary Function Test (PFT) database. Maneuvers were deemed acceptable if () the flow-volume loop showed rapid rise and smooth descent; () the back extrapolated volume (V_be), the volume leaked by a subject prior to the forced maneuver, was ≤80 ml and 12.5% of forced vital capacity (FVC); and () cessation of expiratory flow was at a point ≤10% of peak expiratory flow rate (PEFR). Repeatability was determined by another acceptable maneuver with forced expiratory volume in t seconds (FEV_t) and FVC within 10% or 0.1 L of the best acceptable maneuver. Post hoc analysis compared spirometry values for those with asthma and cystic fibrosis to normative values. Results. Two hundred and forty-eight preschool children performed spirometry for the first time between August 26, 2006, and August 25, 2008. At least one technically acceptable maneuver was found in 82.3% (n = 204) of the tests performed. Overall, 54% of children were able to perform acceptable and repeatable spirometry based on the ATS criteria. Children with asthma or cystic fibrosis did not have spirometry values that differed significantly from healthy controls. However, up to 29% of the overall cohort displayed at least one abnormal spirometry value. Conclusions. Many preschool-aged children are able to perform technically acceptable and repeatable spirometry under normal conditions in a busy clinical setting. Spirometry may be a useful screen for abnormal lung function in this age group.

Keywords :

• asthma
• child
• cystic fibrosis preschool
• spirometry

Acknowledgments

Dr. Gaffin is supported by NIH KL2 RR025757-0 1, Harvard Clinical and Translational Science Center (KL1), and the American Thoracic Society Fellow Career Development Award, which was made possible by an educational grant from GlaxoSmithKline; Dr. Phipatanakul is funded by NIH/NIAID R-01grant (AI-073964) and NIH/NHLBI AsthmaNet 1U10HL098102.