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Published ahead of print on March 17, 2004, doi:10.1164/rccm.200310-1453OC

Am. J. Respir. Crit. Care Med., Volume 169, Number 10, May 2004, 1152-1159

A more recent version of this article appeared on May 15, 2004
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Submitted on November 3, 2003
Accepted on March 14, 2004

Quality Control for Spirometry in Pre-school Children with and without Lung Disease

Paul Aurora1*, Janet Stocks2, Cara Oliver2, Clare Saunders2, Rosemary Castle2, Greg Chaziparasidis2, and Andrew Bush3

1 Portex Respiratory Unit, Institute of Child Health, London, United Kingdom; Cardiorespiratory and Critical Care Division, Great Ormond Street Hospital for Children, London, United Kingdom, 2 Portex Respiratory Unit, Institute of Child Health, London, United Kingdom, 3 Department of Paediatric Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom

* To whom correspondence should be addressed. E-mail: p.aurora{at}ich.ucl.ac.uk.

The reliability of spirometry is dependent upon strict quality control. We examined whether quality control criteria recommended for adults could be applied to children aged 2-5 years. Forty-two children with cystic fibrosis and 37 healthy children attempted spirometry during their first visit to our laboratory. While 59 children (75%) were able to produce a technically satisfactory forced expiration lasting 0.5 seconds, only 46 (58%) could produce an expiration lasting one second, with the youngest children having the most difficulty. Start of test criteria for adults were inappropriate for this age group, with only 16/59 children producing a volume of back extrapolation as a proportion of forced vital capacity of less than 5%, whereas all but four could produce a volume of back extrapolation of >= 80mL. Over 90% of children were able to produce a second forced vital capacity and a second forced expired volume in 0.75 seconds within 10% of their highest. Errors in the spirometry software resulted in inaccurate reporting of expiratory duration and inappropriate timed expired volumes in some children. We describe recommendations for modified start of test and repeatability criteria for this age group, and for improvements in software to facilitate better quality control.
Key words: spirometry, children, preschool, quality control




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