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The importance of spirometry in the assessment of childhood asthma
1Department of Pediatrics, Albert Einstein College of Medicine, Yeshiva University, Bronx, NY 10461.
Insights
Pulmonary function tests reveal that many children with asthma have undiagnosed airflow obstruction even when they appear well. This underdiagnosis can lead to persistent issues into adulthood.
Area of Science:
- Pediatric Pulmonology
- Respiratory Medicine
- Clinical Pediatrics
Background:
- Asthma is a common chronic respiratory disease in children.
- Routine follow-up visits are crucial for managing pediatric asthma.
- Assessing pulmonary function in asymptomatic children is important for comprehensive care.
Purpose of the Study:
- To evaluate the pulmonary function of children diagnosed with asthma during routine visits when they exhibit no current symptoms.
- To identify potential underdiagnosis of airflow obstruction in clinically well pediatric asthma patients.
Main Methods:
- Pulmonary function tests, including spirometry, were conducted on 65 children with a prior asthma diagnosis.
- Participants had no symptoms for at least six weeks and normal physical examinations and peak flow rates.
- Data collected included forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC) ratio and mid-maximal expiratory flow.
Main Results:
- The mean FEV1/FVC ratio was 80% +/- 8% of predicted values.
- The mean mid-maximal expiratory flow was 66% +/- 23% of predicted values.
- A significant proportion of children showed abnormalities: 17% had FEV1/FVC < 72% and 54% had mid-maximal expiratory flow < 65% of predicted.
Conclusions:
- Spirometry is essential for detecting airflow obstruction in children with asthma, even when they appear clinically well.
- Failure to perform spirometry can lead to underdiagnosis of persistent obstruction.
- Undetected obstruction may contribute to long-term respiratory problems, including progression to hyperinflation and persistence into adulthood.
Objective:
To assess the pulmonary function of children with asthma at the time of a routine follow-up visit when they were judged to be clinically well.
Design:
Pulmonary function tests were performed on children with a previous diagnosis of asthma. None had had any symptoms for at least 6 weeks. All had normal Wright peak flow rates and normal findings at physical examination.
Setting:
General pediatric and pediatric pulmonary clinic at a municipal hospital in the Bronx, NY.
Patients:
Sixty-five children with asthma who fit the above criteria. All were able to perform spirometry adequately. Their mean (+/- SD) age was 11 +/- 3 years, and their median age was 10 years.
Selection Procedures:
All clinic patients were screened as possible participants. The 65 patients were deemed eligible, and were willing and able to perform spirometry.
Interventions:
None.
Measurements And Results:
The group's mean (+/- SD) forced expiratory volume in 1 second/forced vital capacity ratio was 80% +/- 8%, and their mean mid-maximal expiratory flow was 66% +/- 23% of the predicted value. Of the 65 patients, 11 (17%) had forced expiratory volume in 1 second/forced vital capacity ratios of less than 72%, and 35 (54%) had a mid-maximal expiratory flow of less than 65% of the predicted value.
Conclusion:
Failure to perform spirometry in children with asthma results in underdiagnosis of airflow obstruction. This may result in obstruction persisting into adulthood and/or progression to hyperinflation.