Spirometry in Primary Care for Children With Asthma
Spirometry is an essential part of diagnosing a child with asthma. The National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) expert panels recommend spirometry to be performed on children five years of age and older as an objective assessment of lung function, to diagnosis asthma, and for ongoing yearly management of asthma (GINA, 2012; NAEPP, 2007). According to the NAEPP expert panel, history and physical examination alone are not reliable to accurately diagnose asthma, exclude alternative diagnosis, or determine lung impairment (NAEPP, 2007). Dombkowski, Hassan, Wasilevich, and Clark (2010) found 52% of physicians who provide primary care to children used spirometry, but only 21% used spirometry according to the national guidelines, and only 35% of physicians surveyed were comfortable interpreting the test results. Zanconato, Meneghelli, Braga, Zacchello, and Baraldi (2005) found that 21% of spirometry readings were interpreted incorrectly, concluding that proper training and quality control were important to provide if spirometry in the primary care office setting is to be used. The purpose of this article is to review the appropriate use of spirometry in pediatric primary care.
Asthma is the most common chronic condition diagnosed in childhood and has a significant impact on quality of life. In the United States, seven million children (9.5%) are living with asthma (Centers for Disease Control and Prevention [CDC], 2011). Non-Hispanic Black children and poor families have even higher rates of asthma, 16% and 13%, respectively (CDC, 2011). Asthma may be variable over time, and yearly spirometry, or more often as needed, should be used to evaluate disease severity and management. Asthma control, medication administration technique, the written asthma action plan, treatment adherence, and concerns should be assessed based on spirometry results at health care visits.
Two goals of asthma therapy are to reduce both respiratory impairment and risk of complications associated with asthma. Reduced respiratory impairment can be determined by decreased episodes of coughing or shortness of breath, use of inhaled short-acting beta2-agonist (SABA) for quick relief of symptoms less than two days a week, and maintaining near-normal pulmonary function and the individual's normal activity levels. Risk reduction is characterized by the prevention of recurrent exacerbations of asthma and minimizing the need for emergency department (ED) visits or hospitalizations, prevention of reduced lung growth in children with asthma, and provision of optimal pharmacotherapy with minimal or no adverse effects of therapy (National Asthma Education and Prevention Program [NAEPP], 2007). Follow-up assessments and continuous monitoring of symptoms and management strategies are important to maintain goals. Objective measures of pulmonary function can be obtained by using a peak flow meter, but spirometry testing is considered a more reliable and valid measurement of respiratory function and asthma severity.
Abstract and Introduction
Abstract
Spirometry is an essential part of diagnosing a child with asthma. The National Asthma Education and Prevention Program (NAEPP) and the Global Initiative for Asthma (GINA) expert panels recommend spirometry to be performed on children five years of age and older as an objective assessment of lung function, to diagnosis asthma, and for ongoing yearly management of asthma (GINA, 2012; NAEPP, 2007). According to the NAEPP expert panel, history and physical examination alone are not reliable to accurately diagnose asthma, exclude alternative diagnosis, or determine lung impairment (NAEPP, 2007). Dombkowski, Hassan, Wasilevich, and Clark (2010) found 52% of physicians who provide primary care to children used spirometry, but only 21% used spirometry according to the national guidelines, and only 35% of physicians surveyed were comfortable interpreting the test results. Zanconato, Meneghelli, Braga, Zacchello, and Baraldi (2005) found that 21% of spirometry readings were interpreted incorrectly, concluding that proper training and quality control were important to provide if spirometry in the primary care office setting is to be used. The purpose of this article is to review the appropriate use of spirometry in pediatric primary care.
Introduction
Asthma is the most common chronic condition diagnosed in childhood and has a significant impact on quality of life. In the United States, seven million children (9.5%) are living with asthma (Centers for Disease Control and Prevention [CDC], 2011). Non-Hispanic Black children and poor families have even higher rates of asthma, 16% and 13%, respectively (CDC, 2011). Asthma may be variable over time, and yearly spirometry, or more often as needed, should be used to evaluate disease severity and management. Asthma control, medication administration technique, the written asthma action plan, treatment adherence, and concerns should be assessed based on spirometry results at health care visits.
Two goals of asthma therapy are to reduce both respiratory impairment and risk of complications associated with asthma. Reduced respiratory impairment can be determined by decreased episodes of coughing or shortness of breath, use of inhaled short-acting beta2-agonist (SABA) for quick relief of symptoms less than two days a week, and maintaining near-normal pulmonary function and the individual's normal activity levels. Risk reduction is characterized by the prevention of recurrent exacerbations of asthma and minimizing the need for emergency department (ED) visits or hospitalizations, prevention of reduced lung growth in children with asthma, and provision of optimal pharmacotherapy with minimal or no adverse effects of therapy (National Asthma Education and Prevention Program [NAEPP], 2007). Follow-up assessments and continuous monitoring of symptoms and management strategies are important to maintain goals. Objective measures of pulmonary function can be obtained by using a peak flow meter, but spirometry testing is considered a more reliable and valid measurement of respiratory function and asthma severity.
Source...