The use of spirometers and peak flow meters in the diagnosis and management of asthma among Spanish pediatricians. Results from the TRAP study.

Abstract

The objective of this study was to determine the level of adherence of pediatricians in Spain to the Spanish National Guidelines for Asthma Treatment with regard to the use of a peak flow meter (PEFR) or a spirometer in the diagnosis and management of asthma in childhood and to analyze sources of variations in these practices. A prospective survey (consisting of demographic and asthma knowledge sections) was conducted over a 2-wk time interval of 3000 pediatricians throughout the country. At least one part of the questionnaire was completed and returned by 2773 individuals (92.4%), with 2347 (78.2%) answering both sections; results are for this population. Around 62% of the pediatricians reported having a peak flow meter or a spirometer in their office; however, only 33% and 48% of them used the devices for the diagnosis and treatment of asthma, respectively. There was a significant association between being older (36-55 yr old) and using PEFR or spirometry for the diagnosis (OR: 1.35, 95% CI 1.11-1.66) and the management (OR 1.47, 95% CI 1.22-1.77) of asthma. Males used a peak flow meter or a spirometer more often than females for the diagnosis (37.8% vs. 30.9%, p = 0.001) and management of asthma (52.0% vs. 45.6%, p = 0.008). Pediatricians with formal pediatric residence training used these devices more for the diagnosis (OR: 1.39, 95% CI 1.09-1.75) and management (OR: 1.58, 95% CI 1.27-1.96) than those without. Working in a hospital was also related with more peak flow meter or spirometer use than working in health centers (OR: 2.08, 95% CI 1.71-2.54 for diagnosis; OR: 1.83, 95% CI 1.50-2.22 for management). About one-third of the Spanish pediatricians surveyed use spirometers and/or peak flow meters for diagnosing asthma and about half use one of these devices occasionally for managing the disease. Independent factors favoring their use are: age 36-55 yr, male gender, working in a hospital setting, and having been trained in a formal pediatric residence program.