Child Health Division, Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia.
Cough & Airways Research Group, Australian Centre for Health Services Innovation, Queensland University of Technology, Brisbane, Queensland, Australia.
Pediatr Pulmonol. 2022 Oct;57(10):2390-2397. doi: 10.1002/ppul.26045. Epub 2022 Jul 6.
Spirometry provides a quantitative measure of lung function and its use is recommended as an adjunct to enhance pediatric respiratory healthcare in many clinical practice guidelines. However, there is limited evidence confirming the benefits (or otherwise) of using spirometry from either clinician or patient perspectives. This systematic review aimed to determine the impact of spirometry on change in clinical decision making and patient-reported outcome measures. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, www.clinicaltrials.gov, and World Health Organization International Clinical Trials Registry Platform, from inception to July 2021. We included randomized controlled trials (RCTs) comparing the use versus non-use of spirometry during standard clinical review in children aged <18 years with respiratory problems in clinics. We used Cochrane methodology. The search identified 3475 articles; 8 full-text articles were reviewed but only 1 study fulfilled the inclusion criteria. The single study involved two cluster RCTs of spirometry for children with asthma in general practice. The included study did not find any significant intergroup difference at the 12-month follow-up for asthma-related quality-of-life and clinical endpoints. However, the findings were limited by methodological weaknesses and high risks of bias. With a paucity of data, the clinical benefits of spirometry remain unclear. Thus, there is a clear need for RCTs that provide high-quality evidence to support the routine use of spirometry in children with suspected or known lung disease. Pending the availability of better evidence, we recommend that clinicians adhere to the current clinical practice recommendations.
肺量测定法提供了一种定量测量肺功能的方法，许多临床实践指南都建议将其作为增强儿科呼吸道保健的辅助手段。然而，从临床医生或患者的角度来看，使用肺量测定法的益处（或其他方面）的证据有限。本系统评价旨在确定肺量测定法对临床决策和患者报告的结果测量的变化的影响。我们检索了 PubMed、Embase、Cochrane 对照试验中心注册库、www.clinicaltrials.gov 和世界卫生组织国际临床试验注册平台，检索时间从建库到 2021 年 7 月。我们纳入了比较在诊所中患有呼吸道问题的<18 岁儿童标准临床评估中使用与不使用肺量测定法的随机对照试验（RCT）。我们使用 Cochrane 方法学。检索共确定了 3475 篇文章；对 8 篇全文进行了评估，但只有 1 项研究符合纳入标准。该研究涉及一般实践中针对哮喘儿童的肺量测定法的两项整群 RCT。纳入的研究在 12 个月的随访中，在哮喘相关生活质量和临床终点方面，两组间未发现任何显著差异。然而，研究结果受到方法学缺陷和高偏倚风险的限制。由于数据有限，肺量测定法的临床益处仍不清楚。因此，迫切需要 RCT 提供高质量的证据，以支持在疑似或已知肺部疾病的儿童中常规使用肺量测定法。在获得更好的证据之前，我们建议临床医生遵守当前的临床实践建议。
