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      Calidad de la espirometría en preescolares Translated title: Spirometry quality in preschool children

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          Abstract

          Fundamento. La realización de maniobras espirométricas de calidad en niños preescolares tanto en el diagnóstico como en el seguimiento de enfermedades respiratorias sigue siendo muy escaso, por diversas razones entre las que se encuentran la falta de un consenso en los criterios de calidad y aceptabilidad de la prueba. Por ello, se inició este estudio con el fin de obtener ecuaciones de referencia provenientes de una población de niños preescolares sanos de la Comunidad Foral de Navarra (España). Métodos. Se incluyeron un total de 114 niños preescolares sanos con edades comprendidas entre los 3 y los 7 años y sin experiencia previa en la realización de estudios de función pulmonar. Resultados. Un total de 76 fueron capaces de realizar al menos dos maniobras espirométricas de aceptables y de ellos 60 aceptables y reproducibles, de acuerdo a los criterios ATS/ERS, lo cual representa un porcentaje global de éxito de 59%. El fallo más habitual fue la terminación prematura y brusca de la maniobra espirométrica, seguido de un pico espiratorio inadecuado. Conclusiones. Más de la mitad de los preescolares fueron capaces de realizar espirometrías de calidad. Nuestros datos permiten recomendar los criterios de calidad propuestos, como adecuados para su uso rutinario, y fomentar el uso de la espirometría en la práctica clínica habitual, dentro del entorno de la atención especializada.

          Translated abstract

          Background. Carrying out quality spirometric maneuvers in preschool children in both the diagnosis and follow-up of respiratory diseases continues to be very scarce. This is due to several reasons, including a lack of consensus on quality criteria and the acceptability of the test. The purpose of this study is therefore to obtain reference norms from a population of healthy preschool children from the Autonomous Community of Navarre (Spain). Method. A total of 114 healthy preschool children aged between 3 and 7 years of age, without prior experience in carrying out lung function tests, were included. Results. A total of 76 were able to realize at least two acceptable spirometric maneuvers, and 60 of them maneuvers that were acceptable and reproducible, according to ATS/ERS criteria. This represents a global success percentage of 59%. The most common failing was premature and brusque termination of the spirometric maneuver, followed by an inadequate peak in breathing. Conclusions. Over half of the preschool children were able to realize quality spirometric maneuvers. Our data make it possible to recommend the proposed quality criteria as being suitable for routine use, and to encourage the use of spirometry in regular clinical practice within the setting of specialized care.

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          Most cited references47

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          Interpretative strategies for lung function tests.

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            Reference values for lung function: past, present and future.

            Reliable interpretation of pulmonary function results relies on the availability of appropriate reference data to help distinguish between health and disease and to assess the severity and nature of any functional impairment. The overwhelming number of published reference equations, with at least 15 published for spirometry alone in the past 3 yrs, complicates the selection of an appropriate reference. The use of inappropriate reference equations and misinterpretation, even when potentially appropriate equations are used, can lead to serious errors in both under and over diagnosis, with its associated burden in terms of financial and human costs. Further misdiagnosis occurs when fixed cut-offs, such as 80% predicted forced expiratory volume in 1 s (FEV(1)) or 0.70 FEV(1)/forced vital capacity, are used; particularly in young children and elderly adults. While per cent predicted has historically been used to interpret lung function results, z-scores are more appropriate as they take into account the predicted value, as well as the between-subject variability of measurements. We aim to highlight some of the main issues in selecting and using reference equations and discuss how recent developments may improve interpretation of pulmonary function results.
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              Quality control for spirometry in preschool children with and without lung disease.

              The reliability of spirometry is dependent on 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. Whereas 59 children (75%) were able to produce a technically satisfactory forced expiration lasting 0.5 second, only 46 (58%) could produce an expiration lasting 1 second, with the youngest children having the most difficulty. Start of test criteria for adults were inappropriate for this age group, with only 16 of 59 children producing a volume of back extrapolation as a proportion of forced vital capacity of less than 5%, whereas all but 4 could produce a volume of back extrapolation of 80 ml or less. More than 90% of children were able to produce a second forced vital capacity and a second forced expired volume in 0.75 second 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.

                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                asisna
                Anales del Sistema Sanitario de Navarra
                Anales Sis San Navarra
                Gobierno de Navarra. Departamento de Salud (Pamplona, Navarra, Spain )
                1137-6627
                April 2014
                : 37
                : 1
                : 81-89
                Affiliations
                [03] Pamplona orgnameNavarrabiomed-Fundación Miguel Servet
                [01] orgnameComplejo Hospitalario de Navarra orgdiv1Laboratorio de Función Pulmonar orgdiv2Servicio de Alergología
                [02] Pamplona orgnameCentro de Salud Conde Oliveto
                Article
                S1137-66272014000100009
                10.4321/S1137-66272014000100009
                12102a05-6398-40c0-82f1-6cc02c3bed34

                This work is licensed under a Creative Commons Attribution-NonCommercial 3.0 International License.

                History
                : 14 September 2013
                : 03 February 2014
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 30, Pages: 9
                Product

                SciELO Spain


                Espirometría,Niños preescolares,Valores de referencia,Calidad,Maniobras espirométricas,Spirometry,Preschool children,Reference values,Quality,Spirometric maneuvers

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