Protocol - Spirometry - Child

Description

The procedures for performing spirometry with a child are very similar to those for performing spirometry with an adult. However, young children require more training and visual cues (e.g., animation), and they may have a greater number of unsuccessful spirometry test maneuvers. The results from children’s spirometry tests are also more variable than those from adults’ tests.

Specific Instructions

This protocol may be administered to children as young as 3 to 6 years of age; however, young children may not fully comprehend the instructions and may have fewer successful spirometry attempts.

See Table 2 of Aurora et al., 2004 for the success rates of forced expiratory parameters by age. Of healthy children aged 2 to 6, 78% were successful with FVC and FEV0.5 tests and 71% of children with cystic fibrosis in the same age groups were successful with the same tests.

The Sickle Cell Disease Curative Therapy Working Group recommends that this protocol be performed in transplant patients at one time point pre-transplant (baseline) and 100 days, six months, and annually post-hematopoietic cell transplant (HCT). The Working Group notes that a reduction in forced expiratory volume in 1 second (FEV1) can be caused by chronic graft versus host disease (GvHD) of the lungs.

Availability

Available

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Protocol

The following description summarizes some of the key points. For the full protocol, see Beydon et al., 2007 and Miller et al., 2005.

Equipment

Spirometers usually come with computer software. The spirometer must be connected to a computer during the spirometry tests. Provide the child with his/her own mouthpiece and nose clip. Allow the child to put the mouthpiece in the mouth and blow with the nose clip on the nose. Record whether or not a nose clip was used.

Demonstration

Provide a brief explanation of the spirometry test. Do multiple demonstrations of the spirometry test for the child. Encourage the child to inspire fully into the spirometer and blow fast. Ideally this demonstration and the spirometry tests are performed with visual cues via animation software. Instructions may need to be tailored to the child.

Setting

The child may be standing up or sitting in a chair. The position should be noted.

Successful maneuvers

After the child blows into the spirometer, the technician determines if the attempt was a successful “maneuver.” The child should have at least two to three successful and reproducible maneuvers, which may take up to 15 attempts.

Recommended end of test criteria:

1) The subject cannot or should not continue further exhalation.

2) The volume-time curve shows no change in volume (<0.025 L) for ³1 s, and the subject has tried to exhale for ³3 s in children aged <10 yrs and for ³6 s in subjects aged >10 yrs.

Recorded results

(Some children will not be able to expire for a full second.)

Forced Vital Capacity (FVC)
Forced Expiratory Volume in .5 seconds (FEV_.5)
Forced Expiratory Volume in .75 seconds (FEV_.75)
Forced Expiratory Volume in 1 second (FEV₁)
Repeatability of parameters above
Number of satisfactory attempts (maneuvers)
Posture
Nose clips

Variability of results

A child’s spirometry results may not be as repeatable as an adult’s results. Repeatable results should be recorded.

Personnel and Training Required

Technician trained in conducting pulmonary function tests (PFTs) with a spirometer.

Equipment Needs

The primary instrument used in pulmonary function testing is the spirometer.

Requirements

Requirement Category	Required
Major equipment	No
Specialized training	Yes
Specialized requirements for biospecimen collection	No
Average time of greater than 15 minutes in an unaffected individual	No

Mode of Administration

Physical Measurement

Lifestage

Child

Participants

Preschoolers (ages 3-6) and children

Selection Rationale

This protocol is recommended by the American Thoracic Society and the European Respiratory Society and represents 15 years of preparation and review by expert committees.

Language

English

Standards

Standard	Name	ID	Source
caDSR Form	PhenX PX091602 - Spirometry Child	6872376	caDSR Form

Derived Variables

None

Process and Review

The Expert Review Panel #6 (ERP 6) reviewed the measures in the Respiratory domain.

Guidance from ERP 6 includes:

• New child protocol for the Spirometry measure

• New Data Dictionary

Protocol Name from Source

Beydon, N., et al, An official American Thoracic Society/European Respiratory Society statement: Pulmonary function testing in preschool children, AM J RESP CRIT CARE, 2007

Source

Beydon, N., Davis, S. D., Lombardi, E., Allen, J. L., Arets, H. G., Aurora, P., … Wilson, N. M. (2007). An official American Thoracic Society/European Respiratory Society statement: Pulmonary function testing in preschool children. American Journal of Respiratory and Critical Care Medicine, 175(12), 1304-1345.

Miller, M. R., Hankinson, J., Brusasco, V., Burgos, F., Casaburi, R., Coates, A., … Wanger, J. (2005). Standardisation of spirometry. European Respiratory Journal, 26(2), 319-338.

General References

Aurora, P., Stocks, J., Oliver, C., Saunders, C., Castle, R., Chaziparasidis, G., Bush, A. (2004). Quality control for spirometry in preschool children with and without lung disease. American Journal of Respiratory and Critical Care Medicine, 169(10): 1152-1159.

Gaffin, J. M., Shotola, N. L., Martin, T. R., & Phipatanakul, W. (2010). Clinically useful spirometry in preschool-aged children: Evaluation of the 2007 American Thoracic Society Guidelines. Journal of Asthma, 47(7), 762-767.

Protocol ID

91602

Variables

Export Variables

Variable Name	Variable ID	Variable Description	dbGaP Mapping
PX091602_Spirometry_Preschool_Child_Demonstration
	PX091602030000	Was the child provided a demonstration and more encouraged to inspire fully into the spirometer and blow fast? show less	N/A
PX091602_Spirometry_Preschool_Child_Forced_Expiratory_Volume_1
	PX091602090000	What is the Forced Expiratory Volume in 1 more second (FEV1)? show less	N/A
PX091602_Spirometry_Preschool_Child_Forced_Expiratory_Volume_5
	PX091602070000	What is the Forced Expiratory Volume in .5 more seconds (FEV.5)? show less	N/A
PX091602_Spirometry_Preschool_Child_Forced_Expiratory_Volume_75
	PX091602080000	What is the Forced Expiratory Volume in .75 more seconds (FEV.75)? show less	N/A
PX091602_Spirometry_Preschool_Child_Forced_Vital_Capacity
	PX091602060000	What is the Forced Vital Capacity (FVC)?	N/A
PX091602_Spirometry_Preschool_Child_Manuever_Successful
	PX091602050000	Was the manuever successful? The child more should have at least two to three successful and reproducible manuevers show less	N/A
PX091602_Spirometry_Preschool_Child_Mouthpiece_Nose_Clip
	PX091602010000	Was the child allowed put the mouthpiece more into his/her mouth and blow with the nose clip on the nose? show less	N/A
PX091602_Spirometry_Preschool_Child_Nose_Clip
	PX091602020000	Was a nose clip used?	N/A
PX091602_Spirometry_Preschool_Child_Position
	PX091602040000	Which position is the child in during this test?	N/A
PX091602_Spirometry_Preschool_Child_Repeatability_Parameters
	PX091602100000	What is the repeatability of parameters above?	N/A
PX091602_Spirometry_Preschool_Child_Satisfactory_Maneuvers_Number
	PX091602110000	What is the number of satisfactory attempts more (maneuvers)? show less	N/A

Respiratory

Measure Name

Spirometry

Release Date

January 29, 2010

Definition

Spirometry is a common pulmonary function test (PFT) measuring the amount (volume) and/or speed (flow) of air being inhaled and exhaled.

Purpose

Spirometry is a tool used to screen for the presence of obstructive and restrictive lung diseases.

Keywords

Respiratory, pulmonary function test, PFT, American Thoracic Society, ATS, European Respiratory Society, ERS, forced vital capacity, FVC, forced expiratory volume, FEV

Measure Protocols

Protocol ID	Protocol Name
91601	Spirometry - Adult
91602	Spirometry - Child

Publications

There are no publications listed for this protocol.