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American Journal of Respiratory and Critical Care Medicine Vol 178. pp. 107, (2008)
© 2008 American Thoracic Society

Correspondence

Quality Control for Spirometry in Preschool Children

To the Editor:

We read with great interest the "Official American Thoracic Society [ATS]/European Respiratory Society [ERS] Statement: Pulmonary Function Testing in Preschool Children" (1), and in particular section 3, in which recommendations for spirometry in preschool children were discussed. Our research team has developed quality control criteria for spirometry in preschool children (2), but these were not mentioned or referred to by Beydon and colleagues in the ATS/ERS document (1). Indeed, we read in the section "Interpretation of results/criteria for accepting data" (p. 1312) that "there is only one published study reporting this index (VBE), in the preschool age group" (that of Aurora and coworkers [3]).

Our study applied spirometry to a population of preschool children with asthma to refine the quality control criteria proposed by Aurora and coworkers (3). Since their dataset was rather small (79 children), we also aimed to study a larger population (207 children). In addition, our study had the advantage of determining the optimal threshold by a mathematical method, while Aurora and coworkers determined this threshold on a more arbitrary basis using only graphic analysis. Our study suggests that lower back-extrapolated volume (VBE) thresholds (VBE ≤ 75 ml ≤ 10% of FVC) can be used than those proposed by Aurora and coworkers (3) (VBE ≤ 80 ml and ≤ 12.5% of FVC), and we feel that our analysis of the cumulative plots of success rate in determining different thresholds for VBE and VBE/FVC is a more rigorously mathematical approach.

In addition to calculations of VBE and VBE/FVC, we also reported a threshold for time to peak expiratory flow (PEF), following an ATS recommendation to include this measurement when conducting research on assessment of the subject's correct performance of FVC maneuvers. The optimal, mathematically determined cutoff in our study was 120 ms, the same as that defined by an ATS optional recommendation for adults. Concerning repeatability criteria, the threshold for absolute {Delta}FVC (in ml) in our study was similar to that obtained by Aurora and coworkers (100 ml), but we determined a higher percentage threshold for {Delta}FVC, 12.5%, than that found by Aurora and coworkers (10%).

Véronique Nève, Régis Matran and Jean-Louis Edmé

Centre Hospitalier et Universitaire de Lille
Université Lille 2
Lille, France

FOOTNOTES

Conflict of Interest Statement: None of the authors has a financial relationship with a commercial entity that has an interest in the subject of this manuscript.

REFERENCES

  1. Beydon N, Davis SD, Lombardi E, Allen JL, Arets HGM, Aurora P, Bisgaard H, Davis GM, Ducharme FM, Eigen H, et al. An official American Thoracic Society/European Respiratory Society Statement: pulmonary function testing in preschool children. Am J Respir Crit Care Med 2007;175:1304–1345.[Free Full Text]
  2. Nève V, Edmé JL, Devos P, Deschildre A, Thumerelle C, Santos C, Methlin CM, Matran M, Matran R. Spirometry in 3–5 year old children with asthma. Pediatr Pulmonol 2006;41:735–743.[CrossRef][Medline]
  3. Aurora P, Stocks J, Oliver C, Saunders C, Castle R, Chaziparasidis G, Bush A; for the London Cystic Fibrosis Collaboration. Quality control for spirometry in preschool children with and without lung disease. Am J Respir Crit Care Med 2004;169:1152–1159.[Abstract/Free Full Text]




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Proc. Am. Thorac. Soc. Am. J. Respir. Cell Mol. Biol.
Copyright © 2008 American Thoracic Society