Spirometry fails to improve quality of life in asthmatic children

By Afsaneh Gray, medwireNews Reporter

The results of two cluster randomised controlled trials in young asthma patients reveal that regular spirometry and medical review do not significantly affect asthma-related quality of life, report Australian researchers.

Their findings call into question advice given to doctors, such as in the Australian Asthma Management Handbook, which recommends that spirometry and regular medical review be performed in children old enough to properly perform a forced expiratory manoeuvre.

Lead author Michael Abramson (Monash University, Melbourne, Victoria) and colleagues recruited 238 asthma patients aged between 7 and 17 years in two trials, one based in Melbourne and one in South Australia and Tasmania.

Participants were randomly assigned to either receive an intervention that included spirometry and regular medical review or usual care. All patients had been prescribed inhaled medicine in the preceding 6 months and were free of complex medical conditions such as cancer or mental illness.

Asthma-related quality of life was measured using the Pediatric Asthma Impact Scale^TM in one trial and the Juniper Pediatric Asthma Quality of Life Questionnaire in the other.

Because of differences in the measurement properties between the trials, a formal meta-analysis could not be performed.

Overall, quality of life improved from baseline to 12 months in all groups in both trials, but neither trial found any difference in asthma-related quality of life between those receiving spirometry and those receiving usual care .

The adjusted differences between spirometry and control at 12 months were just 0.20 points in the Melbourne trial and 0.17 points in the South Australia/Tasmania trial.

Furthermore, spirometry did not have a significant effect on asthma exacerbations, limitation to usual activities, nocturnal cough, bother during physical activity, worry about asthma or receiving a written asthma action plan.

The authors note that, “Spirometry and regular review would only be expected to have an effect if accompanied by appropriate prescription and adherence to preventive medication”.

Although they did not collect complete data on inhaled corticosteroids and adherence in both trials, there was a trend to improved adherence in the Melbourne intervention group.

Writing in Pediatric Pulmonology, the researchers conclude: “The findings do not support more widespread use of spirometry for the management of childhood asthma in general practice.

“New models of integrated asthma management in general practice should be explored in children with sub-optimal asthma control.”

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