Zanconato Stefania, Meneghelli Giorgio, Braga Raffaele, Zacchello Franco, Baraldi Eugenio
Department of Pediatrics, University of Padova, Padova, Italy.
Pediatrics. 2005 Dec;116(6):e792-7. doi: 10.1542/peds.2005-0487.
The aim of this study was to investigate the validity of office spirometry in primary care pediatric practices.
Ten primary care pediatricians undertook a spirometry training program that was led by 2 pediatric pulmonologists from the Pediatric Department of the University of Padova. After the pediatricians' training, children with asthma or persistent cough underwent a spirometric test in the pediatrician's office and at a pulmonary function (PF) laboratory, in the same day in random order. Both spirometric tests were performed with a portable turbine flow sensor spirometer. We assessed the quality of the spirometric tests and compared a range of PF parameters obtained in the pediatricians' offices and in the PF laboratory according to the Bland and Altman method.
A total of 109 children (mean age: 10.4 years; range: 6-15) were included in the study. Eighty-five (78%) of the spirometric tests that were performed in the pediatricians' offices met all of the acceptability and reproducibility criteria. The 24 unacceptable test results were attributable largely to a slow start and failure to satisfy end-of-test criteria. Only the 85 acceptable spirometric tests were considered for analysis. The agreement between the spirometric tests that were performed in the pediatrician's office and in the PF laboratory was good for the key parameters (forced vital capacity, forced expiratory volume in 1 second, and forced expiratory flow between 25% and 75%). The repeatability coefficient was 0.26 L for forced expiratory volume in 1 second (83 of 85 values fall within this range), 0.30 L for forced vital capacity (81 values fall within this range), and 0.58 L/s for forced expiratory flow between 25% and 75% (82 values fall within this range). In 79% of cases, the primary care pediatricians interpreted the spirometric tests correctly.
It seems justifiable to perform spirometry in pediatric primary care, but an integrated approach involving both the primary care pediatrician and certified pediatric respiratory medicine centers is recommended because effective training and quality assurance are vital prerequisites for successful spirometry.
本研究旨在调查基层医疗儿科诊所中办公室肺功能测定的有效性。
10名基层医疗儿科医生参加了由帕多瓦大学儿科系的2名儿科肺科医生主导的肺功能测定培训项目。在儿科医生培训结束后，患有哮喘或持续性咳嗽的儿童在同一天以随机顺序在儿科医生办公室和肺功能（PF）实验室接受肺功能测试。两项肺功能测试均使用便携式涡轮流量传感器肺功能仪进行。我们评估了肺功能测试的质量，并根据布兰德和奥特曼方法比较了在儿科医生办公室和PF实验室获得的一系列PF参数。
共有109名儿童（平均年龄：10.4岁；范围：6 - 15岁）纳入研究。在儿科医生办公室进行的肺功能测试中，85次（78%）符合所有可接受性和可重复性标准。24次不可接受的测试结果主要归因于起始缓慢和未满足测试结束标准。仅对85次可接受的肺功能测试进行分析。在儿科医生办公室和PF实验室进行的肺功能测试之间，关键参数（用力肺活量、第1秒用力呼气量和25%至75%之间的用力呼气流量）的一致性良好。第1秒用力呼气量的重复性系数为0.26 L（85个值中的83个在此范围内），用力肺活量为0.30 L（81个值在此范围内），25%至75%之间的用力呼气流量为0.58 L/s（82个值在此范围内）。在79%的病例中，基层医疗儿科医生对肺功能测试的解读正确。
在儿科基层医疗中进行肺功能测定似乎是合理的，但建议采用基层医疗儿科医生和认证儿科呼吸医学中心相结合的方法，因为有效的培训和质量保证是成功进行肺功能测定的重要先决条件。
