The Impact of Spirometry on Pediatric Asthma Diagnosis and Treatment

Abstract

Holt EW, Tan J, Hosgood HD. J Asthma. 2006;43:489–493 PURPOSE OF THE STUDY. To evaluate the use of spirometry as a diagnostic tool in a pediatric asthma-management program at an inner-city community health clinic. STUDY POPULATION. The study profiled 56 pediatric patients who presented with respiratory symptoms that were indicative of an acute asthma exacerbation. METHODS. Clinicians recorded each patient's history of asthma symptoms as well as heart rate, respiratory rate, and pulse oximetry. Patients then were assessed for current asthma symptoms and given an initial assessment of asthma, upper respiratory infection, or both. An initial treatment plan for nonreactive airway management, albuterol, yellow-zone management, and/or prednisone/prelone treatment was recorded. After the initial symptom-based diagnosis, a pulmonary-function test was performed by using spirometry measurements. The clinician concluded the visit by making a final assessment of asthma or upper respiratory infection and assigned a final treatment plan that was based on standardized asthma plans. RESULTS. The most frequently reported physical symptom was general coughing (73.2%), followed by nighttime cough (50.0%), wheezing (35.7%), and trouble sleeping because of cough (21.4%). Approximately two thirds of the patients in this population had abnormal values of forced expiratory volume in 1 second. Physicians changed 30.4% of the patients’ treatment plans after viewing spirometry results. CONCLUSIONS. Spirometry is an objective tool that can help prevent misclassification of asthma severity and inappropriate use of asthma medication among pediatric patients with asthma. The use of spirometry made an impact in asthma diagnosis at this inner-city clinic: nearly one third of the patients had their treatment plans changed after the spirometry results were viewed. REVIEWER COMMENTS. The emphasis of this study was to examine the impact of spirometry results on physician behavior in the acute setting. It demonstrates that when clinicians follow the National Asthma Education and Prevention Program guidelines for recommended spirometry use, there were considerable differences in recommendations for treatment. Ensuring appropriate diagnosis cannot solely rely on patients’ signs and symptoms; thus, pediatricians should consider spirometry in asthmatic children.