Spirometry in 5-year-olds-validation of current guidelines and the relation with asthma

• Published in: Pediatric pulmonology Vol. 42; no. 12; pp. 1144 - 1151
• Main Authors: Turner, Stephen W., Craig, Leone C.A., Harbour, Paul J., Forbes, Sarah H., McNeill, Geraldine, Seaton, Anthony, Devereux, Graham, Helms, Peter J.
• Format: Journal Article
• Language: English
• Published: Hoboken Wiley Subscription Services, Inc., A Wiley Company 01.12.2007; Wiley-Liss
• Subjects: asthma; Asthma - diagnosis; Asthma - physiopathology; Biological and medical sciences; child; Child, Preschool; Chronic obstructive pulmonary disease, asthma; Equipment Design; Female; Forced Expiratory Flow Rates - physiology; Forced Expiratory Volume - physiology; General aspects; Humans; Infant; Male; Medical sciences; Pneumology; Practice Guidelines as Topic - standards; Reproducibility of Results; respiratory function tests; Respiratory Sounds - physiopathology; Severity of Illness Index; Spirometry - instrumentation; Spirometry - standards; Spirometry - trends; validation; Vital Capacity - physiology; Human; Validation; Lung disease; Pediatrics; Spirometry; Respiratory disease; Exploration; Recommendation; Asthma; Lung function; respiratory function tests; Bronchus disease; Obstructive pulmonary disease; Child; Pneumology
• ISSN: 8755-6863; 1099-0496
• DOI: 10.1002/ppul.20709

Introduction. Spirometry is more frequently measured in younger children. Our primary aim was to validate 2005 ATS‐ERS Task Force standards for spirometry in adults and older children among a population of 5‐year‐old children. Our secondary aim was to relate spirometry to asthma symptoms. Methods Children were participants in a longitudinal cohort study where asthma symptoms and spirometry were assessed. Results Of the 827 children assessed, spirometry was obtained in 638 (85 with wheeze). A back‐extrapolated volume/FVC ratio of <5% was achieved in 99% of children, the best two FVC were ≤150 ml of each other in 89% and three efforts were obtained within six attempts in 88%. The best two FVC were within 10% of each other in 82% of children. Only 13% achieved a forced expiratory time (FET) of ≥3 sec, whereas 80% had an FET of ≥1 sec. All criteria (including FET ≥1 s and FVC ≤10%) were met in 400 (65%) of the 638 children. Most spirometric indices were reduced in association with current wheeze and a history of asthma; children with current wheeze had a mean reduction of 0.65 FEV1 z score compared to healthy children, P < 0.001. An FEV1 z score of −1.0 had 82% sensitivity but only 50% specificity for current wheeze, the corresponding numbers for an FEF50 z score of −1.0 being 79% and 71%. Conclusions The standards for spirometry are mostly achieved in this age group but are not necessarily valid and require revision. Reliable spirometry is feasible in 5‐year‐old children where reduced measurements are associated with asthma symptoms and in whom FEF50 appears to be the most discriminatory variable. Pediatr Pulmonol. 2007; 42:1144–1151. © 2007 Wiley‐Liss, Inc.