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Office spirometry in primary care pediatrics: a pilot study
Stefania Zanconato1, Giorgio Meneghelli, Raffaele Braga
1Department of Pediatrics, University of Padova, Padova, Italy. zanconato@pediatria.unipd.it
Insights
Office spirometry is valid in pediatric primary care, showing good agreement with lab tests for key lung function parameters. Proper training and quality control are essential for accurate results in children with asthma or cough.
Area of Science:
- Pediatric Pulmonology
- Primary Care Medicine
- Respiratory Diagnostics
Background:
- Spirometry is crucial for diagnosing and managing pediatric respiratory conditions.
- Its utility in primary care settings has been questioned due to potential variability in test quality.
Purpose of the Study:
- To evaluate the accuracy and reliability of spirometry performed by primary care pediatricians.
- To compare office-based spirometry results with those obtained in a specialized pulmonary function laboratory.
Main Methods:
- Pediatricians received spirometry training from pulmonologists.
- Children underwent same-day spirometry in the office and a PF lab using identical equipment.
- Data were analyzed using Bland and Altman methods to assess agreement and quality criteria.
Main Results:
- 78% of office spirometry tests met acceptability criteria.
- Good agreement was observed for forced vital capacity, FEV1, and FEF25-75% between office and lab tests.
- Pediatricians correctly interpreted spirometry results in 79% of cases.
Conclusions:
- Office spirometry is a valid tool in pediatric primary care for assessing lung function.
- Collaboration with certified pediatric respiratory centers and robust training/quality assurance are recommended for optimal implementation.
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.
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