Spirometry Improves Assessment of Asthma Severity in Children

F. Bruder Stapleton, MD

Discordance was identified between spirometry-determined and clinically determined severity scores, particularly in cases of severe asthma.

Clinical symptoms are a mainstay in assessing asthma severity as well as therapeutic control in children. To evaluate the utility of spirometry in this setting, investigators compared asthma severity scores from spirometry with clinically derived ratings using current guidelines in 894 children aged 5 to 19 years identified from an asthmatic referral clinic. Based on clinical severity ratings, 61.7% of patients had intermittent or mild, persistent asthma; 33.4% had moderate, persistent asthma; and 4.8% had severe, persistent asthma.

Initial office spirometry results showed significantly decreased forced vital capacity (FVC) percent predicted, forced expiratory volume in 1 second (FEV1) percent predicted, and FEV1/FVC with increasing clinically determined asthma severity. The associations between clinical and spirometry ratings were similar in younger (aged 5–11 years) and older (aged 12–19 years) children. In 36% of patients, the asthma severity score was worse using spirometry readings compared with clinical scores. When spirometry was performed after inhalation treatment, discordance between spirometry and clinical scores was higher in those with more-severe asthma as determined by spirometry scores (P<0.0001).

Citation(s):

Schifano ED et al. Mismatch between asthma symptoms and spirometry: Implications for managing asthma in children. J Pediatr 2014 Sep 1; [e-pub ahead of print].