title: The role of computer games in measuring spirometry in healthy and "asthmatic" preschool children.
abstract: OBJECTIVE
  To explore the role of respiratory interactive computer games in teaching spirometry to preschool children, and to examine whether the spirometry data achieved are compatible with acceptable criteria for adults and with published data for healthy preschool children, and whether spirometry at this age can assess airway obstruction.
  
  
  METHODS
  Feasibility study.
  
  
  METHODS
  Community kindergartens around Israel and a tertiary pediatric pulmonary clinic.
  
  
  METHODS
  Healthy and asthmatic preschool children (age range, 2.0 to 6.5 years).
  
  
  METHODS
  Multi-target interactive spirometry games including three targets: full inspiration before expiration, instant forced expiration, and long expiration to residual volume.
  
  
  RESULTS
  One hundred nine healthy and 157 asthmatic children succeeded in performing adequate spirometry using a multi-target interactive spirometry game. American Thoracic Society (ATS)/European Respiratory Society spirometry criteria for adults for the start of the test, and repeatability were met. Expiration time increased with age (1.3 +/- 0.3 s at 3 years to 1.9 +/- 0.3 s at 6 years [+/- SD], p < 0.05). FVC and flow rates increased with age, while FEV1/FVC decreased. Healthy children had FVC and FEV1 values similar to those of previous preschool studies, but flows were significantly higher (> 1.5 SD for forced expiratory flow at 50% of vital capacity [FEF50] and forced expiratory flow at 75% of vital capacity [FEF75], p < 0.005). The descending part of the flow/volume curve was convex in 2.5- to 3.5-year-old patients, resembling that of infants, while in 5- to 6-year-old patients, there was linear decay. Asthma severity by Global Initiative for Asthma guidelines correlated with longer expiration time (1.7 +/- 0.4 s; p < 0.03) and lower FEF50 (32 to 63%; p < 0.001) compared to healthy children. Bronchodilators improved FEV1 by 10 to 13% and FEF50 by 38 to 56% of baseline.
  
  
  CONCLUSIONS
  Interactive respiratory games can facilitate spirometry in very young children, yielding results that conform to most of the ATS criteria established for adults and published data for healthy preschool children. Spirometric indexes correlated with degree of asthma severity.
authors.affiliation: Pediatric Pulmonary Unit, The Edmond and Lily Safra Children's Hospital, Chaim Sheba Medical Center, Tel HaShomer, Ramat-Gan 52625, Israel. avi_vil@bezeqint.net
authors.forename: Daphna
authors.initials: D
authors.lastname: Vilozni
authors.forename: Asher
authors.initials: A
authors.lastname: Barak
authors.forename: Ori
authors.initials: O
authors.lastname: Efrati
authors.forename: Arie
authors.initials: A
authors.lastname: Augarten
authors.forename: Chaim
authors.initials: C
authors.lastname: Springer
authors.forename: Yacov
authors.initials: Y
authors.lastname: Yahav
authors.forename: Lea
authors.initials: L
authors.lastname: Bentur
mesh_terms: D000402:Airway Obstruction / Q000175:diagnosis* / Q000209:etiology; D001249:Asthma / Q000150:complications / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003201:Computers; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D008297:Male; D013147:Spirometry / Q000379:methods*; D018910:Video Games