Thompson Rohan, Delfino Ralph J, Tjoa Thomas, Nussbaum Eliezer, Cooper Dan
Department of Medicine, Pediatric Pulmonology Division, Miller Children's Hospital, Long Beach, California,USA.
Pediatr Pulmonol. 2006 Sep;41(9):819-28. doi: 10.1002/ppul.20449.
Home spirometers are useful for monitoring asthma therapy and for research, but the validity of maneuvers in children is in question. We evaluated the quality of PEF, FEV(1), and FVC data obtained from 67 children with persistent asthma who self-administered spirometry at home using the hand-held ndd EasyOne Frontline Spirometer with full expiratory curve data, electronic measurements of maneuver quality, and on-screen incentives. Half were studied in 2003 in one region, and half in 2004 in another region of Southern California. Subjects were followed at home weekly over 2 months and daily over 10 consecutive days. We retained completed spirometry sessions (9,916) consisting of three of six best maneuvers in the morning, afternoon, and evening. Percent compliance, software assessed repeatability and acceptability modified from American Thoracic Society criteria, and visually assessed quality of maneuvers, were compared across daily and weekly follow-up, study regions, and subject characteristics. Compliance was higher for daily (>90%) than for weekly follow-up (>84%), but not significantly different, and was consistent across subject characteristics. The number with two reproducible and acceptable maneuvers was significantly lower in the first than second region for daily (70 vs. 90%) and weekly follow-up (66 vs. 87%). Of 22,926 software accepted maneuvers, 1,944 (8.5%) were visually rejected (variable effort, cough, glottic closure). Maneuver quality was significantly lower for subjects age 9-12 versus 13-18 years, for subjects not taking anti-inflammatory medications, and for subjects with <80% predicted FEV(1). Longitudinal data collection is possible in children with asthma by employing repeated home training and follow-up, and using spirometers with built in quality assurance and incentive software. Region, age, and multiple indicators of persistent asthma, predict ability to perform reliable and accurate lung function maneuvers.
家用肺量计对于监测哮喘治疗和进行研究很有用，但儿童操作的有效性存在疑问。我们评估了67名持续性哮喘儿童使用手持式ndd EasyOne Frontline肺量计在家中自行进行肺功能测定所获得的呼气峰流速（PEF）、第1秒用力呼气容积（FEV₁）和用力肺活量（FVC）数据的质量，该肺量计具有完整的呼气曲线数据、操作质量的电子测量以及屏幕提示。其中一半于2003年在一个地区进行研究，另一半于2004年在南加州的另一个地区进行研究。受试者在家中每周随访2个月，连续10天每天随访。我们保留了完整的肺功能测定记录（9916次），包括早晨、下午和晚上六次最佳操作中的三次。比较了每日和每周随访、研究地区以及受试者特征之间的依从率、软件评估的重复性和根据美国胸科学会标准修改的可接受性，以及视觉评估的操作质量。每日随访（>90%）的依从率高于每周随访（>84%），但差异不显著，且在受试者特征方面保持一致。每日（70%对90%）和每周随访（66%对87%）时，第一个地区两次可重复且可接受操作的人数明显低于第二个地区。在22926次软件接受的操作中，有1944次（8.5%）在视觉上被判定不合格（用力不均、咳嗽、声门关闭）。9至12岁的受试者与13至18岁的受试者相比、未服用抗炎药物的受试者以及预测FEV₁<80%的受试者，其操作质量明显较低。通过采用重复的家庭训练和随访，并使用具有内置质量保证和提示软件的肺量计，对哮喘儿童进行纵向数据收集是可行的。地区、年龄以及持续性哮喘的多个指标可预测进行可靠准确肺功能操作的能力。
