The Influence of Pulmonary Function Testing on the Management of Asthma in Children

Objective

To assess how often in a single encounter that pulmonary function tests (PFTs) influenced management decisions in children with asthma, beyond what was obtained from history and physical examination alone.

Study design

Children with asthma (n = 367, age 4 to 18 years) performed spirometry before clinical evaluation. Physicians and nurse practitioners in the outpatient pulmonary office evaluated the children and made initial treatment recommendations before reviewing the spirometry results. Any changes based on the test results were documented.

Results

Spirometry was abnormal in 45% of the visits, related to underlying asthma severity but not to clinical findings. PFT results changed management decisions in 15% of visits. This frequency was not affected by the patient's age, disease severity, symptom control, or exam findings. When spirometry 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 did change treatment decisions, the provider was more likely to increase therapy (75%) than to maintain (20%) or decrease (5%) therapy.

Conclusion

Without PFTs, providers often overestimated the degree of asthma control. This incorrect assessment could have resulted in suboptimal therapy.

ANOVA, Analysis of variance, FEV₁, Forced expiratory volume in 1 second, FEF_25-75%, Forced expiratory flows between 25% and 75% of vital capacity, NAEEP, National Asthma Education and Prevention Program, PEF, Peak expiratory flow, PFT, Pulmonary function test, ROC, Receiver operating characteristic