ROUTINE PULMONARY-FUNCTION TESTS IN YOUNG ADOLESCENTS WITH ASTHMA IN GENERAL-PRACTICE

Objective: To assess the value of performing routine pulmonary functio n tests by flow-loop spirometry in young adolescents with asthma. Desi gn: A prospective clinical study comparing clinical assessment and pat ients' self-reporting of asthma severity with the results of pulmonary function tests. Setting: General practice in a small rural community of about 30 000 people. Patients: Young adolescents with asthma, aged 10-15 years, were enrolled in the study over a two-year period from Ju ly 1993 to June 1995 when they presented for either elective, interval assessments or with an acute exacerbation of asthma. Main outcome mea sures: Discrepancy between (i) the doctor's and the patient's percepti on of asthma control (six scale measures) and the consequent managemen t plans, and (ii) the results of pulmonary function tests that indicat ed less than adequate airway function (i.e., forced expiratory volume in one second as a percentage of predicted vital capacity for height a nd sex [FEV(1)%] less than 65% or average flow rate over the middle 50 % of forced vital capacity as a percentage of predicted normal value [ FEF(25%-75%)] less than 65%). Results: Twenty-seven adolescents with a sthma were assessed on a total of 37 occasions. The results of pulmona ry function tests did not correlate with asthma symptoms and treatment in 11 of the 37 assessments (30%; 95% confidence interval [CI], 16%-4 7%). The 11 assessments were performed on eight patients. Conclusions: This small community-based study of adolescents with asthma supports the view that pulmonary function testing by flow-loop spirometry shoul d be part of the routine assessment of acute and chronic asthmatics. F urther study in a larger community is needed to clarify the frequency of over- and underestimation of asthma severity in this difficult age group.