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The influence of pulmonary function testing on the management of asthma in children
Suja J Nair1, Karen L Daigle, Peté DeCuir
1Pediatric Pulmonary Division, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
Insights
Pulmonary function tests (PFTs) altered asthma management in 15% of pediatric visits. Without PFTs, providers frequently overestimated asthma control, potentially leading to inadequate treatment.
Area of Science:
- Pediatric Pulmonology
- Asthma Management
- Clinical Decision-Making
Background:
- Asthma management in children relies on clinical assessment.
- Pulmonary function tests (PFTs) provide objective data on lung function.
- The impact of PFTs on clinical decisions in pediatric asthma is not fully understood.
Purpose of the Study:
- To determine the frequency with which PFTs influenced management decisions in a single encounter for children with asthma.
- To assess if PFTs provided additional information beyond history and physical examination.
Main Methods:
- A prospective study involving 367 children (age 4-18) with asthma.
- Spirometry was performed before clinical evaluation.
- Physicians documented initial treatment recommendations before and after reviewing PFT results.
Main Results:
- Abnormal spirometry results were observed in 45% of visits, correlating with asthma severity.
- PFT results led to a change in management decisions in 15% of visits.
- When PFTs changed decisions, therapy was more likely to be increased (75%) than maintained or decreased.
Conclusions:
- Providers may overestimate asthma control without objective PFT data.
- Objective PFT results can guide more appropriate asthma treatment adjustments.
- Incorporating PFTs into routine assessments can optimize pediatric asthma care.
Objective:
To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.
Study Design:
Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented.
Results:
Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy.
Conclusion:
Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.
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