The Science Journal of the American Association for Respiratory Care

2011 OPEN FORUM Abstracts

TPREVALANCE OF OBSTRUCTION SEEN ON SPIROMETRY AT WELL-CHILD VISITS.

Elizabeth Koch, Walter Blower, Julie Feldstein, Asia Munlin, Dianne Stratton, Kathy Witschger; PFT lab, Cincinnati Childrens Hospital, Cincinnati, OH

Background: The 2007 NHLBI Guidelines for the Diagnosis and Management of Asthma recommend spirometry at least every 1 to 2 years for periodic assessment and monitoring of lung function for asthma management. A goal of therapy listed in the guidelines is to maintain (near) "normal" pulmonary function. The Pulmonary Function Testing Lab (PFT lab) and the Pediatric Primary Care Center (PPC) at Cincinnati Children's Hospital Medical Center (CCHMC) collaborated to schedule PFTs in all PPC children age 6 and older who had well child clinic visits and a history of asthma. Prior to this intervention, PPC patients did not have easy access to PFT testing. We hypothesized that a significant percentage of PPC asthmatic patients demonstrate airway obstruction when performing PFTs. Method: An improved scheduling system was implemented, consisting of a specific PFT visit type, linked to the PPC patients. This visit type could be tracked monthly for data analysis by both the PFT lab and the PPC physician. The PFT lab followed ATS/ERS guidelines for spirometry. Interpretable PFTs met ATS/ERS criteria for acceptable and repeatable trials. Results: Over a seven-month period (June 2010 through December 2010), the total number of PPC PFT appointments scheduled was 709. The completed appointments totaled 367 (52%); 342 (48%) were either "no-shows" or rescheduled. The completed PFTs revealed 220 (60%) were interpretable and 146 (40%) were un-interpretable. From the interpretable spirometry, 122 (55%) were normal spirometry and 96 (44%)-showed a degree of obstruction. Of these 96 that showed obstruction, 62 (65%) had a response to a bronchodilator. Conclusion: Collaboration among PFT lab, PPC center and central scheduling dramatically increased the number of patients that had spirometry performed during a well-child clinic visits. A large number (44%) of patients showed obstruction on PFTs and 65% had response to a bronchodilator. These results reinforce the importance of spirometry measurement during well-clinic visits to assist the PPC physicians in their management of patients with a history of asthma.
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