Mortimer Kathleen M, Fallot Andre, Balmes John R, Tager Ira B
Division of Public Health Biology and Epidemiology, University of California, Berkeley, CA 94704, USA.
Chest. 2003 Jun;123(6):1899-907. doi: 10.1378/chest.123.6.1899.
Laboratory-based spirometry is the "gold standard" for the assessment of lung function, both in clinical and research protocols. These spirometers, however, are neither practical nor affordable for home-based monitoring or studies that collect data in multiple locations. Traditionally, peak flowmeters have been used, but they have important limitations.
Based on data from a cohort of 92 children with asthma, we evaluated the agreement between a portable spirometer and a office-based spirometer, using an in-line technique to evaluate measures from the same effort. We compared a range of pulmonary function parameters collected during office-based tests, and also evaluated whether adequate adherence and data quality could be achieved in a home-based study of children with asthma.
The agreement between the devices for the actual values of peak expiratory flow, FEV(1), and forced expiratory flow at 25% of FVC was excellent. The portable device was programmed with customized software to grade each curve using revised American Thoracic Society acceptability and reproducibility criteria. For 74% of the curves, quality grade agreed with a grade assigned by physician review of the curve from the office-based spirometer. During 2 weeks of twice-daily monitoring at home, children completed an average of 23 of 28 possible sessions (83%). Of these, 84% had at least two acceptable and two reproducible curves. Although children >or= 8 years old were not more adherent, they were significantly more likely to achieve acceptable and reproducible curves.
Portable spirometers can provide measurements that are highly comparable to those obtained from "gold standard" laboratory spirometers, and high-quality tracings can be achieved both at home and in the office setting. Visual inspection of the curves by experienced reviewers identified unacceptable curves that were not rejected by the quality control software. Portable spirometers are an important contribution to epidemiologic and clinical studies that require frequent measures of a more broad range of pulmonary function parameters than can be provided by peak flowmeters.
在临床和研究方案中，基于实验室的肺量计是评估肺功能的“金标准”。然而，这些肺量计对于家庭监测或在多个地点收集数据的研究而言，既不实用也难以负担。传统上一直使用峰值流量计，但它们存在重要局限性。
基于92名哮喘儿童队列的数据，我们使用在线技术评估同一用力过程中的测量值，以评估便携式肺量计与办公室用肺量计之间的一致性。我们比较了在办公室测试期间收集的一系列肺功能参数，并评估了在哮喘儿童的家庭研究中是否能够实现足够的依从性和数据质量。
两种设备在呼气峰值流速、第1秒用力呼气容积（FEV₁）以及用力肺活量25%时的用力呼气流量实际值之间的一致性极佳。便携式设备通过定制软件编程，使用修订后的美国胸科学会可接受性和可重复性标准对每条曲线进行分级。对于74%的曲线，质量分级与医生根据办公室用肺量计的曲线审查所分配的分级一致。在在家中进行的为期2周、每天两次的监测期间，儿童平均完成了28次可能监测中的23次（占83%）。其中，84%至少有两条可接受且可重复的曲线。尽管8岁及以上儿童的依从性并不更高，但他们获得可接受且可重复曲线的可能性显著更高。
便携式肺量计能够提供与“金标准”实验室肺量计所获得的测量结果高度可比的测量值，并且在家中和办公室环境中都能获得高质量的描记图。经验丰富的审查人员通过目视检查曲线，识别出了质量控制软件未拒绝的不可接受曲线。便携式肺量计对流行病学和临床研究做出了重要贡献，这些研究需要频繁测量比峰值流量计所能提供的更广泛的肺功能参数。
