Abstract
Introduction There is limited evidence on the efficacy of using spirometry routinely in paediatric practice for improving outcomes.
Objective To determine whether the routine use of spirometry alters clinical decisions and patient-related outcome measures for children managed by respiratory paediatricians.
Methods We undertook a parallel open-label randomised controlled trial involving children (aged 4-18 years) able to perform spirometry in a specialist children's hospital in Australia. Children were randomised to either routine use of spirometry (intervention) or clinical review without use of spirometry (control) for one clinic visit. The primary outcomes were the (a) proportion of children with 'any change in clinical decisions' and (b) 'change score' in clinical decisions. Secondary outcomes were change in patient-related outcome measures assessed by State-Trait Anxiety Inventory (STAI) and Parent-Proxy QoL questionnaire for paediatric chronic cough (PC-QoL).
Results Of 136 eligible children, 106 were randomised. Compared with controls, the intervention group had significantly higher proportion of children with 'any change in clinical decisions' (n=54/54 (100%) vs n=34/52 (65.4%), p<0.001) and higher clinical decision 'change score' (median=2 (IQR 1-4) vs 1 (0-2), p<0.001). Also, improvement was significantly greater in the intervention group for overall STAI score (median=-5 (IQR -10 to -2) vs -2.5 (-8.5, 0), p=0.021) and PC-QoL social domain (median=3 (IQR 0 to 5) vs 0 (-1, 1), p=0.017).
Conclusion The routine use of spirometry in children evaluated for respiratory issues at clinical outpatient review is beneficial for optimising clinical management and improving parent psychosocial well-being.
| Original language | English |
|---|---|
| Article number | e001402 |
| Pages (from-to) | 1-9 |
| Number of pages | 9 |
| Journal | BMJ Open Respiratory Research |
| Volume | 10 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - 11 May 2023 |
Bibliographical note
Funding Information:WB is supported by a Charles Darwin University International PhD scholarship and a 6-month Asia Pacific Society of Respirology scholarship. ABC is supported by a NHMRC senior practitioner fellowship (APP1154302) and Children’s Hospital Foundation (top-up #50286) and reports multiple project grants from NHMRC and other fees to the institution from work relating to IDMC membership of an unlicensed vaccine (GSK), an unlicensed RSV monoclonal antibody (Astrazeneca) and a COVID-19 vaccine (Moderna) outside the submitted work. JMM is supported by an early career fellowship grant from the Queensland Children’s Hospital Foundation (RPC0772019) and the NHMRC Centre for Research Excellence in paediatric bronchiectasis (1170958).
Publisher Copyright:
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.