Chest
Volume 118, Issue 3, September 2000, Pages 665-671
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Clinical Investigations
Pulmonary Function
Quality of Spirometry Test Performance in Children and Adolescents*: Experience in a Large Field Study

https://doi.org/10.1378/chest.118.3.665Get rights and content

Study objective

To determine the ability of childrenand adolescents to meet the American Thoracic Society (ATS) goals forspirometry quality that were based on results from adults.

Design

Observational.

Participants

Morethan 4,000 public school students, ages 9 to 18 years.

Measurements

Spirometry was performed annually for 3years, with the recording of maneuver quality measures of forcedexpiratory time, end-of-test volume, back-extrapolated volume, and timeto peak expiratory flow (PEFT), and the recording of differencesbetween best and second-best FVC, FEV1, and peak expiratoryflow (PEF) values.

Results

Regression analyses showedsignificant influences of participant age, gender, ethnicity, size, clinical status, and previous testing experience, as well asdifferences among individual test technicians. In general, theseinfluences were small and explained little of the variance inperformance. On average, children with a history of asthma or wheezeperformed better quality spirometry than did others. Only PEFT improvedsignificantly from year to year. Overall, only 15% of girls’ testsand 32% of boys’ tests met the PEFT criterion derived from adults inthe Lung Health Study.

Conclusion

Most of thechildren met adult-based ATS goals for spirometry test performance. Agegroup-specific criteria are needed to ensure adequately fast PEFT and reproducible PEF values.

Section snippets

Materials and Methods

Students from public schools in 12 middle-income communitieswith diverse air pollution patterns in southern California werestudied. In year 1 (1993), students in grades 4, 7, and 10 wereenrolled. In year 4, a new cohort of grade 4 students was enrolled. Subjects were evaluated annually from January through June byspirometry and by questionnaires on respiratory health and environmental exposures. They were tested at their schools, usually ingroups of ≥ 12. As many as six technicians performed

Results

Table 1gives descriptive statistics for each performance variable, based on9,355 test sessions over 3 years (5,561 test sessions over the earlier2 years for best vs second-best differences). The percentages of testsessions failing to meet each ATS and LHS (adult-based)maneuver-acceptability criterion and each reproducibility criterionwere the following: EOTV, 2%; FET, 5%; BEV, 7%; d, FVC, 3%;dFEV1, 7%; and d, PEF, 10%.

Table 2summarizes regression results for the four performance variables

Discussion

In general, the spirometry quality of the children and adolescentsin our study compared favorably with that of adults studiedelsewhere.78910111213 The thresholds specified by the, ATS1 and LHS6 spirometry acceptability and reproducibility criteria were set so that about 5% of adults failed tomeet each criterion when tested by an experienced technician using adiagnostic-quality spirometry system. Our results show that childrenaged ≥ 9 years also can meet each of the ATS criteria about 95% ofthe

Summary

We found that most schoolchildren who are ≥ 9 years can performforced expiratory spirometric maneuvers well enough to meet currentlyestablished adult-based maneuver acceptability criteria for BEV, EOTV,and FET, as well as within-test session maneuver reproducibility for, FEV1, FVC, and PEF. Factors related to age, size, gender, ethnicity, and subject-technician affinity can influenceperformance, but their overall effect is small with well-trainedtechnicians who have experience. Our findings

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Supported by the California Air Resources Board (contract No. A033–186), the National Institute of Environmental Health Sciences(grant No. 5P30ES07048–02), the US Environmental Protection Agency(contract No. CR824034–01-3), and the Hastings Foundation.

The statements and conclusions in this report are those of the authors and not necessarily those of the California Air Resources Board (or other sponsors). The mention of commercialproducts and their source or use in connection with the materialreported herein is not to be construed as actual or implied endorsementof such products.

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