The Science Journal of the American Association for Respiratory Care

2000 OPEN FORUM Abstracts

ACHIEVING ATS PERFORMANCE STANDARDS FOR SPIROMETRY, LUNG VOLUMES, AND AIRWAY MECHANICS IN PEDIATRIC ASTHMATICS

Blonshine, SB, RRT, RPFT, FAARC, Honicky, RE. MD, King, Kathleen L. MSN, PNP Michigan State University, East Lansing, Michigan

Background: Spirometry is recommended by the NAEPP for the initial asthma patient evaluation, during therapeutic interventions, and annually thereafter with a primary goal to maintain normal lung function. By 6 years of age most children with coaching can reliably perform spirometry (FVC). Other tests include lung volumes (TGV) and airway mechanics (Raw) measurements. We asked the question as to which tests of lung function could children reliably perform and at what level of quality for the diagnosis and monitoring of pediatric asthma.
Method: We conducted a retrospective analysis of 71 current asthmatic patients, ages 4-18 years, with pre and post aerosol bronchodilator FVC, TGV and Raw results derived from the MedGraphics 1085 plethysmograph. All testing was performed by 2 RTs trained and evaluated to be competent in pediatric testing. Our PF lab performance standards are described in the 1998 ATS Management & Procedure Manual for PF Laboratories, Chapters 6, 8 and 9. Each trial was evaluated for conformance with ATS acceptability and reproducibility criteria. A 1-8 progressive quality score (QS) was assigned to each pre and post FVC, TGV, and Raw result; i.e., within 5% reproducibility for FVC, FEV1, TGV and 10% reproducibility for sGaw. A QS of 1 represents 0 acceptable (A) or reproducible (R) trials. A QS of 8 represents 3 acceptable, reproducible trials.

Results: A QS was assigned to 71 patients, both pre- and post-dilator, 142 total results.

Quality Score Achieved Spirometry % of total Age Range Lung volumes % of total Age Range Raw % of total Age Range
1 (0 A, 0 R) 5.6 % 6-15 11.3 % 6-15 4.2 % 6-15
2 (1 A, 0 R) .1 % 8 4.2 % 7-13 0 %
3 (0 A, ³ 2 R) 3.5 % 8-11 31.7 % 4-14 2.1 % 8,9
4 (2 A, 0 R) 1.4 % 9 .1 % 14 0 %
5 (1 A, ³ 2 R) 2.8 % 9,13 3.5 % 7-18 2.1 % 8,11
6 (3 A, 0 R) 8.5 % 7-14 1.4 % 14,18 1.4 % 11
7 (2 A, ³ 2 R) 2.8 % 4,10 3.5 % 6-14 2.1 % 9,11
8 (3 A, ³ 2 R) 74.6 % 4-18 43.7 % 4-16 88.9 % 4-18
Mean QS: Raw 7.49, spirometry 7.01, lung volumes 5.14, Mean age: 10

Conclusion: In our study, Raw measurements achieved the highest quality scores. The spirometry QS appears to be in line with published data for this age group. Lung volumes were the most difficult measurements for us to obtain in this pediatric population. A lower QS did not correlate with any particular age. Most young children can perform all of the PF tests and some adolescents were unable to do many of the tests. Raw measurements provided us with useful data on which to make therapeutic decisions, especially when archived and used for longitudinal patient care decision-making. Raw is performed in a shorter timeframe than spirometry, requires less patient cooperation and effort, yields reliable results, has continuity with Raw measurements made in the neonatal period, and offers a cost-effective approach to evidence-based treatment of

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