Spirometry in 5-year-olds--validation of current guidelines and the relation with asthma

Pediatr Pulmonol. 2007 Dec;42(12):1144-51. doi: 10.1002/ppul.20709.


Introduction: Spirometry is more frequently measured in younger children. Our primary aim was to validate 2005 ATS-ERS Task Force standards for spirometry in adults and older children among a population of 5-year-old children. Our secondary aim was to relate spirometry to asthma symptoms.

Methods: Children were participants in a longitudinal cohort study where asthma symptoms and spirometry were assessed.

Results: Of the 827 children assessed, spirometry was obtained in 638 (85 with wheeze). A back-extrapolated volume/FVC ratio of <5% was achieved in 99% of children, the best two FVC were < or =150 ml of each other in 89% and three efforts were obtained within six attempts in 88%. The best two FVC were within 10% of each other in 82% of children. Only 13% achieved a forced expiratory time (FET) of > or =3 sec, whereas 80% had an FET of > or =1 sec. All criteria (including FET > or =1 s and FVC < or =10%) were met in 400 (65%) of the 638 children. Most spirometric indices were reduced in association with current wheeze and a history of asthma; children with current wheeze had a mean reduction of 0.65 FEV(1) z score compared to healthy children, P < 0.001. An FEV(1) z score of -1.0 had 82% sensitivity but only 50% specificity for current wheeze, the corresponding numbers for an FEF(50) z score of -1.0 being 79% and 71%.

Conclusions: The standards for spirometry are mostly achieved in this age group but are not necessarily valid and require revision. Reliable spirometry is feasible in 5-year-old children where reduced measurements are associated with asthma symptoms and in whom FEF(50) appears to be the most discriminatory variable.

Publication types

  • Research Support, Non-U.S. Gov't
  • Validation Study

MeSH terms

  • Asthma / diagnosis*
  • Asthma / physiopathology
  • Child, Preschool
  • Equipment Design
  • Female
  • Forced Expiratory Flow Rates / physiology
  • Forced Expiratory Volume / physiology
  • Humans
  • Infant
  • Male
  • Practice Guidelines as Topic / standards*
  • Reproducibility of Results
  • Respiratory Sounds / physiopathology
  • Severity of Illness Index
  • Spirometry / instrumentation
  • Spirometry / standards
  • Spirometry / trends*
  • Vital Capacity / physiology