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Spirometry Use in Children Hospitalized with Asthma

Tan, Chee Chun
http://rave.ohiolink.edu/etdc/view?acc_num=ucin1321888428

Abstract Details

2011, MS, University of Cincinnati, Medicine: Clinical and Translational Research.
Rationale: Asthma is the most common chronic disorder of childhood and continues to be a common cause of hospital admission. The National Asthma Education and Prevention Program Expert Panel (NAEPP) recommends spirometry to be obtained on admission, after bronchodilator during the acute phase, and at least another before discharge from the hospital. The objectives of this study were to describe the use of spirometry in children hospitalized with asthma and determine the association of pulmonary function near discharge with future exacerbations. Methods: This was a retrospective cohort study involving reviewing medical records and spirometries of children = 5 years old who were admitted with asthma to Cincinnati Children’s Hospital Medical Center from September 1 2009 to March 31 2011. Asthma re-exacerbation was defined as either having an emergency department (ED) visit or hospitalization for asthma that occurred within 3 months of the index hospitalization. Asthma hospitalization or ED visits were identified by the ICD-9-CM codes of having either a primary diagnosis of asthma (493), or respiratory illnesses (460-496) plus a secondary diagnosis of asthma. All spirometries were performed in a pediatric pulmonary function laboratory. Results: Among 1037 admissions (908 unique patients) included in the study, 89 (8.6%) had spirometry prior to discharge (0.3±0.6 days before discharge). Fifty (56.2%) of those spirometries met American Thoracic Society’s (ATS) criteria for acceptability and repeatability. Those with acceptable spirometry were significantly older than those whose spirometry did not meet ATS criteria (13±4 years vs 11±3, p=0.017). Of these 50 children, 10 (20%) developed an asthma exacerbation within three months following discharge (mean, 32±21 days). Children with re-exacerbation had significantly lower forced expiratory volume in the first second to forced vital capacity ratio (FEV1/FVC) and forced expiratory flow at 25-75% (FEF25-75) with a mean of 68.5±9.0% predicted vs 76.0±9.5% predicted (p=0.038) and 45.6±28.1% vs 65.2±30.2% predicted (p=0.039), respectively. Children who were older (OR=1.4; 95%CI 1.1-1.9) and those with shorter hospital stay (OR=2.8; 95%CI 1.1-7.4) were significantly more likely to have a re-exacerbation. Conclusion: This study showed that few children admitted with asthma had spirometry as recommended in the NAEPP guidelines. Over half of the children over the age of five years were able to perform acceptable spirometry near discharge. Lower lung function especially FEV1/FVC and FEF25-75 near discharge was associated with developing an asthma exacerbation within 3 months following the index admission. Prospective study is needed to confirm these findings.
Erin Nicole Haynes, PHD (Committee Chair)
Carolyn Kercsmar, MD (Committee Member)
Karen McDowell, MD (Committee Member)
17 p.
Surgery
spirometry; children; asthma; hospitalization

Recommended Citations

Citations

  • Tan, C. C. (2011). Spirometry Use in Children Hospitalized with Asthma [Master's thesis, University of Cincinnati]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1321888428

    APA Style (7th edition)

  • Tan, Chee Chun. Spirometry Use in Children Hospitalized with Asthma. 2011. University of Cincinnati, Master's thesis. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=ucin1321888428.

    MLA Style (8th edition)

  • Tan, Chee Chun. "Spirometry Use in Children Hospitalized with Asthma." Master's thesis, University of Cincinnati, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1321888428

    Chicago Manual of Style (17th edition)

ucin1321888428
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This open access ETD is published by University of Cincinnati and OhioLINK.