Portable spirometry during acute exacerbations of asthma in children.
BACKGROUND
Spirometry is the gold standard for assessment of asthma and is objective and non-invasive. This is a pilot study to evaluate whether portable spirometry can be successfully performed by children in the pediatric emergency department for acute exacerbations of asthma.


METHODS
We enrolled children more than 6 years of age presenting to an urban pediatric emergency department with a history of asthma during an acute exacerbation. On arrival and after each bronchodilator treatment, vital signs and a clinical score were recorded. Portable spirometry was then performed. Attempts were continued until acceptable and reproducible measurements were obtained or until the patient was unable to perform further attempts. Outcomes included success at spirometry and correlation of spirometry with clinical signs.


RESULTS
Thirty-four subjects were enrolled with a median age of 12 years. Ninety-one percent of subjects completed at least one attempt at spirometry. Seventy-three percent of all spirometry attempts were reproducible. Portable spirometry demonstrated increased severity of the exacerbation in comparison to clinical signs and peak expiratory flow. Percent of predicted forced expiratory volume in 1 second, ratio of forced expiratory volume in 1 second to forced vital capacity, and peak expiratory flow are all poorly correlated with degree of wheezing, clinical score, respiratory rate, and oxygen saturation (r < 0.5).


CONCLUSIONS
Portable spirometry can be successfully performed by children with acute exacerbations of asthma in the emergency department and demonstrated greater degrees of airway obstruction than did clinical signs. Spirometry provides objective, non-invasive measurements of the severity of airway obstruction in the emergency department for children with acute exacerbations of asthma.
Langhan
Melissa L
ML
Department of Pediatrics, Section of Pediatric Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA. Melissa.Langhan@yale.edu
Spiro
David M
DM
D000293:Adolescent; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D002648:Child; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D005541:Forced Expiratory Volume / Q000502:physiology; D006801:Humans; D010100:Oxygen / Q000097:blood; D010366:Peak Expiratory Flow Rate / Q000502:physiology; D015203:Reproducibility of Results; D015656:Respiratory Mechanics / Q000502:physiology; D012135:Respiratory Sounds / Q000175:diagnosis; D013147:Spirometry / Q000295:instrumentation*; D014797:Vital Capacity / Q000502:physiology; D055815:Young Adult
D010100:Oxygen