IntroductionAlthough spirometry has been available for decades, it is underused in paediatric practice, other than in specialist clinics. This is unsurprising as there is limited evidence on the benefit of routine spirometry in improving clinical decision making and/or outcomes for children. We hypothesised that using spirometry for children being evaluated for respiratory diseases impacts on clinical decision making and/or improves patient-related outcome measures (PROMs) and/or quality of life (QoL), compared with not using spirometry.Methods and analysisWe are undertaking a randomised controlled trial (commenced in March 2020) that will include 106 children (aged 4–18 years) recruited from respiratory clinics at Queensland Children’s Hospital, Australia. Inclusion criteria are able to perform reliable spirometry and a parent/guardian who can complete questionnaire(s). Children (1:1 allocation) are randomised to clinical medical review with spirometry (intervention group) or without spirometry (control group) within strata of consultation status (new/review), and cough condition (present/absent). The primary outcome is change in clinical decision making. The secondary outcomes are change in PROM scores, opinions regarding spirometry and degree of diagnosis certainty. Intergroup differences of these outcomes will be determined by χ2 test or unpaired t-test (or Mann-Whitney if not normally distributed). Change in outcomes within the control group after review of spirometry will also be assessed by McNemar’s test or paired t-test/Wilcoxon signed-rank test.Ethics and disseminationThe Human Research Ethics Committee of the Queensland Children’s Hospital approved the study. The trial results will be disseminated through conference presentations, teaching avenues and publications.Trial registration numberACTRN12619001686190; Pre-results.

Spirometry provides a quantitative measure of lung function and its use is recommended as an adjunct to enhance pediatric respiratory healthcare in many clinical practice guidelines. However, there is limited evidence confirming the benefits (or otherwise) of using spirometry from either clinician or patient perspectives. This systematic review aimed to determine the impact of spirometry on change in clinical decision making and patient-reported outcome measures. We searched PubMed, Embase, Cochrane Central Register of Controlled Trials, www. clinicaltrials.gov, and World Health Organization International Clinical Trials RegistryPlatform, from inception to July 2021. We included randomized controlled trials (RCTs) comparing the use versus non-use of spirometry during standard clinical review in children aged <18 years with respiratory problems in clinics. We used Cochrane methodology. The search identified 3475 articles; 8 full-text articles were reviewed but only 1 study fulfilled the inclusion criteria. The single study involved two cluster RCTs of spirometry for children with asthma in general practice. The included study did not find any significant intergroup difference at the 12-month follow-up for asthma-related quality-of-life and clinical endpoints. However, the findings were limited by methodological weaknesses and high risks of bias. With a paucity of data, the clinical benefits of spirometry remain unclear. Thus, there is a clear need for RCTs that provide high-quality evidence to support the routine use of spirometry in children with suspected or known lung disease. Pending the availability of better evidence, we recommend that clinicians adhere to the current clinical practice recommendations.

No abstract

No abstract

Long-term outcomes of pediatric patients with a tracheostomy in developing countries where professional home nurse is not accessible has rarely been reported. We, therefore, investigated the prevalence and associating factors of long-term outcomes in these children. Retrospective chart review was conducted in 85 tracheostomized children who were discharged to home during January 2012 to December 2020. Tracheostomy home care was provided by caregivers who completed the tracheostomy home care program. Prevalence of unplanned readmission with acute respiratory problems within 30 days after the first hospital discharge was 17.6%. Lower respiratory tract infection (LRTI) after hospital discharge was found in 72.9% (median frequency of 1.0 episode/case/year). Among 80 children who had surveillance airway endoscopy, 46.3% demonstrated late tracheostomy-related airway complications. Independent factor associated with late tracheostomy-related airway complications was a follow-up period longer than 1 year. Decannulation success was found in 21.2%. Most of them had tracheostomy for their upper airway anomalies. The mortality rate was 7%. Most of them died from their underlying diseases. In conclusion, pediatric tracheostomy home care undertaken by caregivers is feasible in developing countries where home nurse is not available. The prevalence of unplanned readmission with acute respiratory problems within 30 days after hospital discharge and late tracheostomy-related airway complications were comparable with those reported in developed countries. However, we still had a high prevalence of post-tracheostomy LRTI which was a challenging problem that needed to be investigated and resolved.

Assessment of caregiver knowledge is an essential part of home healthcare education for pediatric tracheostomy care, however, there is a paucity of evidence in long term. This study aims to determine how caregiver knowledge and misconceptions, as assessed by our knowledge test, changed over a 12-month period following our educational program and whether the test score was associated with any demographics of the caregivers and children with tracheostomy. A prospective cohort study was undertaken to evaluate the knowledge at 3 timepoints after tracheostomy education: baseline (T1), 6 months (T2), and 12 months (T3). Test scores were analyzed for trend and relationship with demographics. Items for which less than 80% caregivers gave correct responses at T1 were considered common misconceptions. Fifty-four caregivers were enrolled. Out of a maximum score of 25, the median (IQR) scores were 22 (21-23), 23 (22-24), and 23 (22-25), at T1, T2, and T3, respectively. The scores at T2 and T3 were significantly higher than at T1 ( P ≤ .01). One common misconception “how to manage when suction got less secretion than expected” was found at all timepoints. Caregivers of children with >2 comorbidities scored slightly higher than those of children with 0 to 2 comorbidities ( P = .01). In conclusion, our caregivers achieved high knowledge scores which increased over the 12-month study period potentially because of repeated assessment and practical experience. Common misconceptions and a factor associated with the knowledge were also identified. These advantages highlighted the importance of knowledge assessment for quality improvement.

Objectives Spirometry is easily accessible yet there is limited data in children with tracheomalacia. Availability of such data may inform clinical practice. We aimed to describe spirometry indices of children with tracheomalacia, including Empey index and flow‐volume curve pattern, and determine whether these indices relate with bronchoscopic features. Methods From the database of children with tracheomalacia diagnosed during 2016–2019, we reviewed their flexible bronchoscopy and spirometry data in a blinded manner. We specially evaluated several spirometry indices and tracheomalacia features (cross‐sectional lumen reduction, malacic length, and presence of bronchomalacia) and determined their association using multivariable regression. Results Of 53 children with tracheomalacia, the mean (SD) peak expiratory flow (PEF) was below the normal range [68.9 percent of predicted value (23.08)]. However, all other spirometry parameters were within normal range [Z‐score forced expired volume in 1 s (FEV1) = −1.18 (1.39), forced vital capacity (FVC) = −0.61 (1.46), forced expiratory flow between 25% and 75% of vital capacity​​​​​​ (FEF25%–75%) = −1.43 (1.10), FEV1/FVC = −1.04 (1.08)], Empey Index = 8.21 (1.59). The most common flow‐volume curve pattern was the “knee” pattern (n = 39, 73.6%). Multivariable linear regression identified the presence of bronchomalacia was significantly associated with lower flows: FEV1 [coefficient (95% CI) −0.78 (−1.54, −0.02)], FEF25%–75% [−0.61 (−1.22, 0)], and PEF [−12.69 (−21.13, −4.25)], all p ≤ 0.05. Other bronchoscopic‐defined tracheomalacia features examined (cross‐sectional lumen reduction, malacic length) were not significantly associated with spirometry indices. Conclusion The “knee” pattern in spirometry flow‐volume curve is common in children with tracheomalacia but other indices, including Empey index, cannot be used to characterize tracheomalacia. Spirometry indices were not significantly associated with bronchoscopic tracheomalacia features but children with tracheobronchomalacia have significantly lower flow than those with tracheomalacia alone.

No abstract