JCNRJournal of Clinical and Nursing Research2208-36852208-3693Bio-Byword Scientific Publishing Pty. Ltd.10.26689/jcnr.v6i3.3964ArticleOverview of Spirometry and the Use of Its Parameters for Asthma Monitoring in Childrenhttps://artdesignp.com/journal/JCNR/6/3/10.26689/jcnr.v6i3.3964TonySara M,AbdelrahmanMona A,Abd ElsalamMogeda,ShafikMahmoud Sameer,AbdelrahimMohamed EA2022632022-05-12Asthma is the most common chronic pulmonary disease in the world, affecting more than three hundred million people from different races and age groups. Childhood asthma is considered one of the main causes of increased healthcare expenditures, particularly in developing countries. Spirometry is the most essential and commonly used lung function test. It is used mainly for the evaluation of lung function to obtain reliable data used for the detection of lung diseases, such as asthma, as well as for monitoring lung health. The two spirometry parameters, peak expiratory flow rate (PEFR) and forced expiratory volume in one second (FEV1), are effective in the diagnosis and management of patients with asthma. However, FEV1 is preferred as it is a more accurate parameter compared to PEFR for the evaluation and recognition of bronchoconstriction. In children with asthma, the most commonly used lung function parameter for asthma monitoring is FEV1. It was discovered that a decrease in FEV1 is associated with an increase in asthma severity.

Licari A, Castagnoli R, Brambilla I, et al., 2018, Asthma Endotyping and Biomarkers in Childhood Asthma. Pediatric Allergy, Immunology, and Pulmonology, 31(2): 44-55.

Akinbami LJ, Simon AE, Rossen LM, 2016, Changing Trends in Asthma Prevalence Among Children. Pediatrics, 137(1): 1-7.

Zahran HS, Bailey C, Garbe P, et al., 2011, Vital Signs: Asthma Prevalence, Disease Characteristics, and Self-Management Education: United States, 2001-2009. Morbidity And Mortality Weekly Report, 60(17): 547-552.

Anandan C, Nurmatov U, van Schayck OCP, et al., 2010, Is the Prevalence of Asthma Declining? Systematic Review of Epidemiological Studies. Allergy, 65(2): 152-167.

Asher I, Pearce N, 2014, Global Burden of Asthma Among Children. The International Journal of Tuberculosis and Lung Disease, 18(11): 1269-1278.

Lee SC, Kang JS, Chang HH, et al., 2020, Impact of Comorbid Asthma on Severity of Coronavirus Disease (COVID-19). Scientific Reports, 10(1): 1-9.

Burrill A, McArdle C, Davies B, 2021, Lung Function in Children: A Simple Guide to Performing and Interpreting Spirometry. Paediatrics and Child Health, 31(7): 276-283.

Rosenthal M, Bush A, 2002, The Growing Lung: Normal Development, and the Long-Term Effects of Pre-And Postnatal Insults. European Respiratory Monograph, 7: 1-24.

Sim YS, Lee J-H, Lee W-Y, et al., 2017, Spirometry and Bronchodilator Test. Tuberculosis and Respiratory Diseases, 80(2): 105.

Chhabra S, Vijayan VK, Rahman M, et al., 2012, Regression Equations for Spirometry in Children Aged 6 to 17 Years in Delhi Region. Indian Journal of Chest Diseases and Allied Sciences, 54(1): 59.

Kotecha SJ, Watkins J, Paranjothy S, et al., 2012, Effect of Late Preterm Birth on Longitudinal Lung Spirometry in School Age Children and Adolescents. Thorax, 67(1): 54-61.

Kirkby J, Welsh L, Lum S, et al., 2008, The EPICure Study: Comparison of School Spirometry with That Performed in the Lung Function Laboratory. Pediatr Pulmonol, 43: 1233-1241.

Zanconato S, Meneghelli G, Braga R, et al., 2005, Office Spirometry in Primary Care Pediatrics: A Pilot Study. Pediatrics, 116(6): e792-e797.

Dombkowski KJ, Hassan F, Wasilevich EA, et al., 2010, Spirometry Use Among Pediatric Primary Care Physicians. Pediatrics, 126(4): 682-687.

Gaffin JM, Shotola SL, Martin TR, et al., 2010, Clinically Useful Spirometry in Preschool-Aged Children: Evaluation of the 2007 American Thoracic Society Guidelines. Journal of Asthma, 47(7): 762-767.

Kumari A, Devanarayana N, Rajindrajith S, et al., 2018, Clinical Utility of Spirometry in Pre-School Children. Sri Lanka Journal of Child Health, 47(1): 64-68.

Nystad W, Samuelsen S, Nafstad P, et al., 2002, Feasibility of Measuring Lung Function in Preschool Children. Thorax, 57(12): 1021-1027.

Pinto LA, 2011, Feasibility of Performing Spirometry in Preschoolers. J Bras Pneumol, 37(1): 69-74.

Komarow HD, Skinner J, Young M, et al., 2012, A Study of the Use of Impulse Oscillometry in the Evaluation of Children with Asthma: Analysis of Lung Parameters, Order Effect, and Utility Compared with Spirometry. Pediatric Pulmonology, 47(1): 18-26.

American Thoracic Society, European Respiratory SocietyEuropean Respiratory Society, 2015, ATS/ERS Consensus Statement: Raised Volume Forced Expirations in Infants: Guidelines for Current Practice. Am J Respir Crit Care Med, 172(11): 1463-1471.

Araujoa CG, Vianna LC, 2009, How Often Does Spirometry Testing Induce Cardiac Arrhythmias?. Primary Care Respiratory Journal, 18(3): 185-188.

Jat KR, 2013, Spirometry in Children. Primary Care Respiratory Journal, 22(2): 221-229.

Hmood AR, Abdulsada HS, Alhibaly HA, et al., 2014, Routine Office Spirometry Versus European Community Respiratory Health Study Questionnaire. Medical Journal of Babylon, 11(3): 658-666.

Levy ML, Quanjer PH, Booker R, et al., 2009, Diagnostic Spirometry in Primary Care: Proposed Standards for General Practice Compliant with American Thoracic Society and European Respiratory Society Recommendations. Primary Care Respiratory Journal, 18(3): 130-147.

Miller M, Hankinson J, Brusasco V, et al., 2005, Standardisation of Spirometry. Eur Respir J, 26: 319-338.

Graham BL, Steenbruggen I, Miller MR, et al., 2019, Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8): e70-e88.

Milanzi EB, Koppelman GH, Oldenwening M, et al., 2019, Considerations in the Use of Different Spirometers in Epidemiological Studies. Environmental Health, 18(1): 1-8.

Licskai CJ, Sands TW, Paolatto L, et al., 2012, Spirometry in Primary Care: An Analysis of Spirometry Test Quality in a Regional Primary Care Asthma Program. Canadian Respiratory Journal, 19(4): 249-254.

Borg BM, Hartley MF, Fisher MT, et al., 2010, Spirometry Training Does Not Guarantee Valid Results. Respiratory Care, 55(6): 689-694.

Moore V, 2012, Spirometry: Step by Step. Breathe, 8(3): 232-240.

Langan RC, Goodbred AJ, 2020, Office Spirometry: Indications and Interpretation. American Family Physician, 101(6): 362-368.

Redlich CA, Tarlo SM, Hankinson JL, et al., 2014, Official American Thoracic Society Technical Standards: Spirometry in the Occupational Setting. American Journal of Respiratory and Critical Care Medicine, 189(8): 983-993.

Dhule SS, Sunita BM, Gawali SR, 2013, Pulmonary Function Tests in Wind Instrument Players. Int J Sci Res, 2(5): 384-386.

Dreger M, 2020, Spirometry in Occupational Health – 2020. Journal of Occupational and Environmental Medicine, 62(5): e208-e230.

Constant C, Sampaio I, Negreiro F, et al., 2011, Respiratory Disease Screening in School-Aged Children Using Portable Spirometry. Jornal de Pediatria, 87(2): 123-130.

Ayuk AC,

Adaeze C Uwaezuoke SN, Ndukwu CI, et al., 2017, Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice. Clinical Medicine Insights: Pediatrics, 11: 1179556517720675.

Dundas I, Mckenzie S, 2006, Spirometry in the Diagnosis of Asthma in Children. Current Opinion in Pulmonary Medicine, 12(1): 28-33.

Holt E, Tan J, Hosgood III H, 2006, The Impact of Spirometry on Pediatric Asthma Diagnosis and Treatment. Journal of Asthma, 43(7): 489-493.

Sanders DB, Rosenfeld M, Mayer-Hamblett N, et al., 2008, Reproducibility of Spirometry During Cystic Fibrosis Pulmonary Exacerbations. Pediatric Pulmonology, 43(11): 1142-1146.

Vilozni D, Bentur L, Efrati O, et al., 2007, Spirometry in Early Childhood in Cystic Fibrosis Patients. Chest, 131(2): 356-361.

Ahmad FA, Macias CG, Allen JY, 2011, The Use of Incentive Spirometry in Pediatric Patients with Sickle Cell Disease to Reduce the Incidence of Acute Chest Syndrome. Journal of Pediatric Hematology/Oncology, 33(6): 415-420.

Efrati O, Toren A, Duskin H, et al., 2010, Spirometry Follow-Up in Young Children with Hemato-Oncologic Diseases. Medical Science Monitor, 16(3): MT28-MT33.

Vilozni D, Berkun Y, Levi Y, et al., 2010, The Feasibility and Validity of Forced Spirometry in Ataxia Telangiectasia. Pediatric Pulmonology, 45(10): 1030-1036.

Chong HS, Moon ES, Park JO, et al., 2011, Value of Pre-operative Pulmonary Function Test in Surgery for Flaccid Neuromuscular Scoliosis Surgery. Spine (Phila Pa 1976), 36(21): E1391-E1394.

Vieira GM, Oliveira HB, de Andrade DT, et al., 2006, Intraocular Pressure Variation During Weight Lifting. Archives of Ophthalmology, 124(9): 1251-1254.

Devrieze BW, Modi P, Giwa AO, 2020, Peak Flow Rate Measurement, StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK459325/ (Updated August 1, 2021).

Matarese A, Sardu C, Shu J, et al., 2019, Why is Chronic Obstructive Pulmonary Disease Linked to Atrial Fibrillation? A Systematic Overview of the Underlying Mechanisms. International Journal of Cardiology, 276: 149-151.

Barreiro T, Perillo I, 2004, An Approach to Interpreting Spirometry. American Family Physician, 69(5): 1107-1114.

Malerba M, Radaeli A, Olivini A, et al., 2016, Association of FEF25-75% Impairment with Bronchial Hyperresponsiveness and Airway Inflammation in Subjects with Asthma-Like Symptoms. Respiration, 91(3): 206-214.

Andrello AC, Donaria L, de Castro LA, et al., 2021, Maximum Voluntary Ventilation and Its Relationship with Clinical Outcomes in Subjects with COPD. Respiratory Care, 66(1): 79-86.

Hirai T, 2021, Pulmonary Function Tests, in Pulmonary Functional Imaging, Springer Cham, 11-20.

Liu M, Jiang H, Chen J, et al., 2016, Tidal Volume Estimation Using Portable Ultrasound Imaging System. IEEE Sensors Journal, 16(24): 9014-9020.

Petterson S, Kuchta C, Snyder-Mackler L, 2007, Aerobic Metabolism During Exercise, Churchill Livingstone Saint Louis, MO.

Wanger J, Clausen JL, Coates A, et al., 2005, Standardisation of the Measurement of Lung Volumes. European Respiratory Journal, 26(3): 511-522.

Tow, A-E, Graves D, Carter R, 2001, Vital Capacity in Tetraplegics Twenty Years and Beyond. Spinal Cord, 39(3): 139-144.

Suriya P, Arumugam S, 2018, Influence of Varied Breathing Exercises on Vital Capacity and Breath Holding Time Among Kabaddi Players. Ganesar College of Arts and Science, 1(1): 343-346.

David S, Sharma S, 2019, Vital Capacity, StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK541099/ (Updated July 26, 2021).

Lofrese JJ, Lappin SL, 2020, Physiology, Residual Volume, StatPearls Publishing LLC. https://www.ncbi.nlm.nih.gov/books/NBK493170/ (Updated October 20, 2021).

Berglund LG, et al., 2020, Physiological and Toxicological Considerations, in Industrial Ventilation Design Guidebook, Academic Press, 111-226.

Harvey RP, 2009, Uncertainty of Iodine Particulate Deposition in the Respiratory Tract, in Comprehensive Handbook of Iodine: Nutritional, Biochemical and Therapeutic Aspects, Academic Press, 259-273.

Cotes J, 2020, Lung Volumes, in Cotes’ Lung Function, John Wiley & Sons Ltd., 177-185.

Hagan S, Albert T, 2020, Interpretation of Pulmonary Function Tests, in Chalk Talks in Internal Medicine, Springer Nature, 203-207.

Graham BL, Steenbruggen I, Miller MR, et al., 2019, Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. American Journal of Respiratory and Critical Care Medicine, 200(8): e70-e88.

Pellegrino R, Viegi G, Brusasco V, et al., 2005, Interpretative Strategies for Lung Function Tests. European Respiratory Journal, 26(5): 948-968.

Johnson JD, Theurer WM, 2014, A Stepwise Approach to the Interpretation of Pulmonary Function Tests. American Family Physician, 89(5): 359-366.

Backman H, Eriksson B, Hedman L, et al., 2016, Restrictive Spirometric Pattern in the General Adult Population: Methods of Defining the Condition and Consequences on Prevalence. Respiratory Medicine, 120: 116-123.

Diaz-Guzman E, McCarthy K, Siu A, et al., 2010, Frequency and Causes of Combined Obstruction and Restriction Identified in Pulmonary Function Tests in Adults. Respiratory Care, 55(3): 310-316.

Ranu H, Wilde M, Madden B, 2011, Pulmonary Function Tests. The Ulster Medical Journal, 80(2): 84.

National Asthma Education and Prevention Program, 2002, Expert Panel Report: Guidelines for the Diagnosis and Management of Asthma Update on Selected Topics – 2002. The Journal of Allergy and Clinical Immunology, 110(5 Suppl): S141-S219.

National Asthma Education and Prevention Program, 2007, Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Summary Report 2007. The Journal of Allergy and Clinical Immunology, 120(5 Suppl): S94-S138.

Vilozni D, Barak A, Efrati O, et al., 2005, The Role of Computer Games in Measuring Spirometry in Healthy and “Asthmatic” Preschool Children. Chest, 128(3): 1146-1155.

Stout JW, Visness CM, Enright P, et al., 2006, Classification of Asthma Severity in Children: The Contribution of Pulmonary Function Testing. Archives of Pediatrics & Adolescent Medicine, 160(8): 844-850.

Fuhlbrigge AL, Weiss ST, Kuntz KM, et al., 2006, Forced Expiratory Volume in 1 Second Percentage Improves the Classification of Severity Among Children with Asthma. Pediatrics, 118(2): E347-E355.

Frima E-S, Theodorakopoulos I, Gidaris D, et al., 2020, Lung Function Variability in Children and Adolescents With and Without Asthma (LUV Study): Protocol for a Prospective, Nonrandomized, Clinical Trial. JMIR Research Protocols, 9(8): e20350.

Reddel H, Ware S, Marks G, et al., 1999, Differences Between Asthma Exacerbations and Poor Asthma Control. The Lancet, 353(9150): 364-369.

NICE, 2017, Asthma: Diagnosis, Monitoring and Chronic Asthma Management, National Institute for Health and Care Excellence (NICE).

Hassan MF, Sharif N, Khan MI, et al., 2011, Relationship Between FEV1 and PEF in Patients with Obstructive Lung Diseases. Ann Pak Inst Med Sci, 7(3): 150-155.

Gallucci M, Carbonara P, Pacilli AMG, et al., 2019, Use of Symptoms Scores, Spirometry, and Other Pulmonary Function Testing for Asthma Monitoring. Frontiers in Pediatrics, 7: 54.

Moeller A, Carlsen K-H, Sly PD, et al., 2015, Monitoring Asthma in Childhood: Lung Function, Bronchial Responsiveness and Inflammation. European Respiratory Review, 24(136): 204-215.

Ulrik C, 1999, Outcome of Asthma: Longitudinal Changes in Lung Function. European Respiratory Journal, 13(4): 904-918.

National Heart, Lung, and Blood Institute, 2007, National Asthma Education and Prevention Program: Expert Panel Report 3 (EPR-3): Guidelines for the Diagnosis and Management of Asthma – Full Report 2007. US Department of Health and Human Services: National Institutes of Health.

Killian KJ, Watson R, Otis J, et al., 2000, Symptom Perception During Acute Bronchoconstriction. American Journal of Respiratory and Critical Care Medicine, 162(2): 490-496.

Rosi E, Stendardi L, Binazzi B, et al., 2006, Perception of Airway Obstruction and Airway Inflammation in Asthma: A Review. Lung, 184(5): 251-258.

GINA, 2020, Global Strategy for Asthma Management and Prevention 2020, GINA Fontana, WI.

Ullmann N, Mirra V, Di Marco A, et al., 2018, Asthma: Differential Diagnosis and Comorbidities. Frontiers in Pediatrics, 6: 276.

Yoos HL, Kitzman H, McMullen A, et al., 2002, Symptom Monitoring in Childhood Asthma: A Randomized Clinical Trial Comparing Peak Expiratory Flow Rate with Symptom Monitoring. Annals of Allergy, Asthma & Immunology, 88(3): 283-291.

Reddel H, Marks G, Jenkins C, 2004, When Can Personal Best Peak Flow Be Determined for Asthma Action Plans?. Thorax, 59(11): 922-924.

Kerstjens H, Brand PL, de Jong PM, et al., 1994, Influence of Treatment on Peak Expiratory Flow and Its Relation to Airway Hyperresponsiveness and Symptoms. The Dutch CNSLD Study Group. Thorax, 49(11): 1109-1115.

Frey U, Brodbeck T, Majumdar A, et al., 2005, Risk of Severe Asthma Episodes Predicted from Fluctuation Analysis of Airway Function. Nature, 438(7068): 667-670.

Julius SM, Davenport KL, Davenport PW, 2002, Perception of Intrinsic and Extrinsic Respiratory Loads in Children with Life?Threatening Asthma. Pediatric Pulmonology, 34(6): 425-433.

Nuijsink M, Hop WCJ, de Jongste JC, et al., 2013, Perception of Bronchoconstriction: A Complementary Disease Marker in Children with Asthma. Journal of Asthma, 50(6): 560-564.

Brand PL, Duiverman EJ, Waalkens HJ, et al., 1999, Peak Flow Variation in Childhood Asthma: Correlation with Symptoms, Airways Obstruction, and Hyperresponsiveness During Long Term Treatment with Inhaled Corticosteroids. Thorax, 54(2): 103-107.

Bateman ED, Boushey HA, Bousquet J, et al., 2004, Can Guideline-Defined Asthma Control Be Achieved? The Gaining Optimal Asthma Control Study. American Journal of Respiratory and Critical Care Medicine, 170(8): 836-844.

Juniper E, O’Byrne PM, Guyatt GH, et al., 1999, Development and Validation of a Questionnaire to Measure Asthma Control. European Respiratory Journal, 14(4): 902-907.

Jenkins C, Thien FCK, Wheatley JR, et al., 2005, Traditional and Patient-Centred Outcomes with Three Classes of Asthma Medication. European Respiratory Journal, 26(1): 36-44.

Quezada W, Kwak ES, Reibman J, et al., 2016, Predictors of Asthma Exacerbation Among Patients with Poorly Controlled Asthma Despite Inhaled Corticosteroid Treatment. Annals of Allergy, Asthma & Immunology, 116(2): 112-117.

Teach SJ, Gergen PJ, Szefler SJ, et al., 2015, Seasonal Risk Factors for Asthma Exacerbations Among Inner-City Children. Journal of Allergy and Clinical Immunology, 135(6): 1465-1473.

Franklin JM, Grunwell JR, Bruce AC, et al., 2017, Predictors of Emergency Department Use in Children with Persistent Asthma in Metropolitan Atlanta, Georgia. Annals of Allergy, Asthma & Immunology, 119(2): 129-136.

Reddel HK, et al., 2009, An Official American Thoracic Society/European Respiratory Society Statement: Asthma Control and Exacerbations: Standardizing Endpoints for Clinical Asthma Trials and Clinical Practice. American Journal of Respiratory and Critical Care Medicine, 180(1): 59-99.