Nair SJ, Daigle KL, DeCuir P, Lapin CD, Schramm CM. J Pediatr. 2005;147:797–801
PURPOSE OF THE STUDY. To assess how preevaluation pulmonary-function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.
STUDY POPULATION. Children with asthma (N = 367) aged 4 to 18 years.
METHODS. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the specific spirometry results. Any changes based on the test results were documented.
RESULTS. Spirometry results were abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of the visits. This frequency was not affected by the patient's age, disease severity, symptom control, or examination findings. When spirometry results 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 results 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.
REVIEWER COMMENTS. This was a very practical clinical study that addressed a common clinical scenario that physicians who treat asthma face daily in clinical practice. Ideally, the patient's presenting clinical history, physical examination, and PFT result should all be factored into the final clinical decision regarding asthma therapy. The data from this investigation demonstrate that spirometry results were abnormal in almost one half of the visits, and this was related to underlying asthma severity and not clinical findings. When the spirometry results did not enter into the management decision, therapy was generally maintained; however, when spirometry results were factored in, the provider was more likely to increase therapy. With this in mind, proper interpretation of PFT data should help prevent overestimation of the degree of asthma control and help prevent suboptimal therapy. An obvious extension of this investigation would be the examination of serial PFTs in patients with asthma to identify clinically relevant trends in these data to assist in the best possible decision-making regarding ongoing asthma therapy and control.
- Copyright © 2007 by the American Academy of Pediatrics