The influence of pulmonary function testing on the management of asthma in children.
OBJECTIVE
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.
Nair
Suja J
SJ
Pediatric Pulmonary Division, Connecticut Children's Medical Center, Hartford, Connecticut 06106, USA.
Daigle
Karen L
KL
DeCuir
Peté
P
Lapin
Craig D
CD
Schramm
Craig M
CM
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis*; D002648:Child; D002675:Child, Preschool; D003237:Connecticut; D003657:Decision Making; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008487:Medical History Taking; D010366:Peak Expiratory Flow Rate; D010808:Physical Examination; D012372:ROC Curve; D012680:Sensitivity and Specificity; D013147:Spirometry