Nair Suja J, Daigle Karen L, DeCuir Peté, Lapin Craig D, Schramm Craig M
Pediatric Pulmonary Division, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
J Pediatr. 2005 Dec;147(6):797-801. doi: 10.1016/j.jpeds.2005.07.023.
To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.
Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented.
Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry did not change treatment decisions, the provider was more likely to maintain therapy (58%) than to increase (17%) or decrease (24%) therapy. In contrast, when spirometry did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy.
Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.
评估在单次就诊中，肺功能测试（PFTs）对哮喘儿童管理决策的影响频率，超出仅通过病史和体格检查所获得的信息。
哮喘儿童（n = 367，年龄4至18岁）在临床评估前进行肺活量测定。门诊肺科办公室的医生和执业护士对儿童进行评估，并在查看肺活量测定结果之前做出初始治疗建议。记录基于测试结果的任何变化。
45%的就诊中肺活量测定异常，这与潜在的哮喘严重程度有关，而非临床检查结果。PFT结果在15%的就诊中改变了管理决策。该频率不受患者年龄、疾病严重程度、症状控制或检查结果的影响。当肺活量测定未改变治疗决策时，医疗服务提供者更有可能维持治疗（58%），而非增加（17%）或减少（24%）治疗。相比之下，当肺活量测定改变治疗决策时，医疗服务提供者更有可能增加治疗（75%），而非维持（20%）或减少（5%）治疗。
若不进行PFTs，医疗服务提供者往往会高估哮喘控制程度。这种错误评估可能导致治疗效果欠佳。
