Spirometry in Asthma Care: A Review of the Trends and Challenges in Pediatric Practice

Abstract

Background:Given the rising incidence of noncommunicable diseases (NCDs) globally, especially bronchial asthma, there is the need to reduce the associated morbidity and mortality by adopting an objective means of diagnosis and monitoring.Aim:This article aims to review the trends and challenges in the use of spirometry for managing childhood bronchial asthma especially in developing countries.Methods:We conducted a literature search of published data on the use of spirometry for the diagnosis of childhood bronchial asthma with special emphasis resource-poor countries.Results:Guidelines for the diagnosis and treatment of childhood asthma recommend the use of spirometry, but this is currently underused in both tertiary and primary care settings especially in developing countries. Lack of spirometers and proper training in their use and interpretation of findings as well as a dearth of asthma guidelines remains core to the underuse of spirometry in managing children with asthma. Targeting education of health care staff was, however, observed to improve its utility, and practical implementable strategies are highlighted.Conclusions:Spirometry is not frequently used for asthma diagnosis in pediatric practice especially in resource-poor countries where the NCD burden is higher. Strategies to overcome the obstacles are implementable and can make a difference in reducing the burden of NCD.

Environmental risk factors for asthma in 13‐14 year old African children

“…Different diagnostic criteria for asthma, lack or variable access to care, lack of access to asthma guidelines, and sub-optimal access to asthma controller medications may contribute to the variations in reported asthma prevalence and severity between centers in our study, and as previously reported. 6,14 The high and varying prevalence of severe asthma especially among those with current asthma may be affected by similar factors and may equally reflect lack of diagnosis or lack of affordable controller therapy or spacer devices to enable effective delivery of medication. 15 Several environmental factors were highly prevalent and were associated with asthma or severe disease.…”

“…This was a cross-sectional study of African adolescents aged [13][14] years who participated in ISAAC III in African centers, between January 2001 and November 2002. Active or passive consenting processing were done to obtain consent from parents and school authorities, according to local ethical guidelines while assent was obtained from participants.…”

“…7 exposure to diverse types of biomass for cooking or heating the home, exposure to tobacco smoke, large family sizes, pets in the home, frequent lower respiratory tract infection, and life style changes that include transition to more sedentary living. 3 The aim of this study was to investigate environmental factors associated with asthma prevalence or severity in [13][14] year old African adolescents participating in ISAAC III.…”

A Retrospective Audit of Pharmacologic and Non-Pharmacologic Management of Childhood Acute Asthma Exacerbation at Usmanu Danfodiyo University Teaching Hospital, Sokoto: Adherence to Global Treatment Guidelines

“…Lack of objective tests to support the diagnosis of asthma has contributed to inappropriate over diagnosis, under diagnosis and misdiagnosis of asthma among school children in Canada ( Yang et al, 2017 ). Ayuk et al (2017b) in their review observed that spirometry is currently under-used in both tertiary and primary care settings in resource poor countries, which was attributed to lack of institutional guidelines for asthma management, lack of spirometers and, where available, healthcare workers were improperly trained to use the tools and interpret the findings appropriately.…”

Reference values for spirometric parameters in healthy children living in a Colombian city located at 2640 m altitude

“…Pulmonary function tests can be used as an aid in helping to diagnose, evaluate, monitor, and follow up pediatric patients with respiratory diseases as well as for assessing the effects of therapeutic interventions . Among the variety of possibilities, spirometry is the most commonly used pulmonary function test for assessing children with suspected or established respiratory conditions and for monitoring normal lung growth in healthy children.…”