Acceptability and repeatability of spirometry in children using updated ATS/ERS criteria

Spirometry in pediatrics can be limited by the child's development which is usually related to age. In 2005 the American Thoracic Society (ATS) and European Respiratory Society (ERS) published updated quality control criteria for spirometry. In 2007 the ATS/ERS published specific criteria for spirometry in preschool children 6 years of age and younger. Our primary objective was to determine the influence of age on the ability of children to meet updated spirometry criteria for acceptable and repeatable tests. Our second objective was to determine which criteria are associated with unacceptable tests. Data was prospectively collected over 12 months for children 4-17 years of age performing spirometry for the first time. Unsuccessful tests were analyzed to determine specific criteria not achieved. Three hundred ninety-three studies were collected and 292 (74%) met recently revised ATS/ERS criteria for acceptable and repeatable tests. Acceptable and repeatable test success was not correlated to the gender or race of the children. The percentage of acceptable and repeatable spirometry increased with age rising above 50% by age 6 and reached a plateau with approximately 85% success at age 10. The most common unmet criteria for an unacceptable study among preschool children was glottic closure and non-maximal efforts, while in school-age children was failure to plateau. These data demonstrate most children are able to perform acceptable/repeatable spirometry with their first effort based on revised ATS/ERS criteria.