Estrategia lúdica para mejorar la calidad de las espirometría y análisis de los valores de referencia en un grupo de escolares de Asunción
DOI:
https://doi.org/10.53732/rccsalud/2024.e6142Palabras clave:
pruebas de función respiratoria, espirometría, capacidad vital, volumen espiratorio forzado, niñoResumen
Introducción. Los niños requieren especial dedicación para lograr espirometrías de calidad. Objetivo. Este trabajo evalúa la frecuencia de maniobras aceptables en escolares, la utilidad de gestos de incentivo para optimizar la obtención de pruebas de alta calidad y realiza un análisis de ajuste a varias ecuaciones de referencia. Materiales y Métodos. Se realizaron maniobras espiratorias forzadas en un grupo de escolares de Asunción- Paraguay, escogiendo variables recomendadas para la interpretación en un espirómetro portátil, para evaluar la frecuencia de pruebas de calidad. Aquellos que no consiguieron estudios aceptables, fueron sometidos a un entrenamiento con silbato en rollo (juguete) para evaluar el desempeño ulterior. Los resultados de alta calidad fueron pareados a valores esperados determinados por diversas ecuaciones buscando evaluar el grado de adecuación. Resultados. De 113 escolares, el 58,4% pudo conseguir maniobras de grado A o B. Después del estímulo con el silbato en rollo, la frecuencia de estudios aceptables ascendió a 79,6%. Los parámetros de referencia con mejor ajuste fueron aquellos determinados por la Global Lung Initiative (GLI). Conclusión. Los incentivos lúdicos son una alternativa para optimizar la obtención de pruebas de espirometría en escolares, que con el uso de parámetros de GLI adecuarían el manejo clínico de ciertas enfermedades respiratorias.
Citas
Reddel H K, Bacharier LB, Ateman ED et al. Global Inititive for Asthma (GINA) Strategy 2021: executive summary and rationale for key changes. Eur Res J 2021. https://erj.ersjournals.com/content/59/1/2102730
Bianchi M, Clavenna A, Sequi M, Bortolotti A, Fortino I, Merlino L et al. Spirometri testing in a population of Italian children: age and gender differences. Respir Med. 2012;106(10):1383-1388. https://doi.org/10.1016/j.rmed.2012.06.005
Bianchi M, Clavenna, Sequi M, Bortolotti A, Fortino I, Merlino L, et al. Childhood asthma management pre- and post- incident asthma hospitalization. PLoS One. 2013;8:e76439. https://doi.org/10.1371/journal.pone.0076439
Aaron SD, Boulet LP, Reddel HK, Gershon AS. Underdiagnosis and Overdiagnosis of Asthma.Am J RespirCrit Care Med. 2018;198(8):1012-1020. https://doi.org/10.1164/rccm.201804-0682CI
Enright PL, Linn WS, Avol EL, Margolis HG, Gong Jr H, Peters JM. Quality of spirometry test performance in children and adolescents: experience in a large field study. Chest. 2000;118(3):665-671. https://doi.org/10.1378/chest.118.3.665
Tomalak W, Radlinski J, Latawiec W. The quality of spirometric measurements in children younger than 10 years of age in the light of recommendations. Adv. Respir. Med. 2008;76(6):421–425. https://doi.org/10.5603/ARM.27860
Quanjer PH, Stanojevic P, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3-95-yr age range: the global lung function 2012 equations. Eur Respir J 2012;40(6):1324–1343 https://doi.org/10.1183/09031936.00080312
Lum S, Bountziouka V, Quanjer P, Sonnappa S, Wade A, Beardsmore C, et al. Challenges in collating spirometry reference data for south-asian children: an observational study. PLoS ONE. 2016;11(4):e0154336. https://doi.org/10.1371/journal.pone.0154336
Caussade S, Contreras I, Villarroel L, Fierro L, Sanchez I, Bertrand P, et al. Valores espirométricos en niños y adolescentes chilenos sanos. Rev. méd. Chile. 2015;143(11):1386-1394. https://doi.org/10.4067/S0034-98872015001100003
World Health Organization. Growth reference data for 5-19 years /Indicators/BMI-for-age (5-19 years). https://www.who.int/tools/growth-reference-data-for-5to19-years/indicators/bmi-for-age
Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26(2):219-338. https://doi.org/10.1183/09031936.05.00034805
European Respiratory Society / Global Lung Function Initiative (GLI). GLI calculators for Spirometry, TLCO and Lung Volume. 2021. http://gli-calculator.ersnet.org/
Zapletal A. Lung function in Children and Adolescents: Methods, reference values. Prog Respir Res. 1987;22:113–218. https://doi.org/10.1159/isbn.978-3-318-04125-5
Polgar G, Promadhat V. Standard values. In: Pulmonary function testing in children: techniques and standards. Philadelphia: W.B. Saunders; 1971. p. 87–212.
Quanjer PH, Stocks J, Polgar G., Wise M., Karlberg J., and Borsboom G. Compilation of reference values for lung function measurements in children. Eur Res J. 1989;4:184S–261S.
Hankinson JL, Odencrantz JR, Fedan KB. Spirometric reference values from a sample of the general U.S. Population. Am J Res Crit Care Med 1999;159(1):179–187. https://doi.org/10.1164/ajrccm.159.1.9712108
Knudson RJ, Lebowitz MD, Holberg CJ, Burrows B. Changes in normal maximal expiratory flow-volume curve with growth and aging. Am Rev Respir Dis. 1983;127(6):725–34. https://pubmed.ncbi.nlm.nih.gov/6859656/
Pérez-Padilla R, Regalado-Pineda J, Mendoza L, Rojas R, Torres V, Borja-Aburto V, et al. Spirometric variability in a longitudinal study of school-age children. Chest. 2003;123(4):1090-1095. https://doi.org/10.1378/chest.123.4.1090
Rosenthal M, Bain SH, Cramer D, Helms P, Denison D, Bush A, Warner JO. Lung function in white children aged 4-19 years: I-Spirometry. Thorax. 1993;48(8):794-802. https://doi.org/10.1136/thx.48.8.794
Ferrante G, La Grutta S. The Burden of Pediatric Asthma. Front Pediatr. 2018;6:186. https://doi.org/10.3389/fped.2018.00186
Gaillard EA, Kuehni CE, Turner S, Goutaki M, Holden KA, de Jong C, et al. European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5–16 years. EurRespir J. 2021;58(5):2004173. https://doi.org/10.1183/13993003.04173-2020
Vanjare N, Chhowala S, Madas S, Kodgule R, Gogtay J, Salvi S. Use of spirometry among chest physicians and primary care physicians in India. npj Prim Care Respir Med. 2016;26:16036. https://doi.org/10.1038/npjpcrm.2016.36
Dombkowski KJ, Hassan F, Wasilevich EA, Clark SJ. Spirometry use among pediatric primary care physicians. Pediatrics. 2010;126(4):682-7. https://pubmed.ncbi.nlm.nih.gov/20819894/
Mannino DM, Buist AS, Petty TL, Enright PL, Redd SC. Lung function and mortality in the United States: data from the First National Health and Nutrition Examination Survey follow up study. Thorax. 2003;58(5):388-93. https://doi.org/10.1136/thorax.58.5.388
Looijmans-van den Akker I, van Luijn K, Verheij T. Overdiagnosis of asthma in children in primary care: a retrospective analysis. Br J Gen Pract. 2016;66(644):e152-7. https://doi.org/10.3399/bjgp16X683965
Gracchi V, Boel M, van der Laag J, van der Ent CK. Spirometry in young children: should computer-animation programs be used during testing? Eur Respir J 2003; 21: 872–875. https://doi.org/10.1183/09031936.03.00059902
Vilozni D, Barker M, Jellouschek H, Heimann G, Blau H. An interactive computer-animated system (SpiroGame) facilitates spirometry in preschool children. Am J Respir Crit Care Med. 2001;164(12):2200–2205. https://doi.org/10.1164/ajrccm.164.12.2101002
Graham BL, Steenbruggen I, Miller MR, Barjaktarevic IZ, Cooper BG, Hall GL, et al. Standardization of Spirometry 2019 Update. An Official American Thoracic Society and European Respiratory Society Technical Statement. Am J Respir Crit Care Med. 2019;200(8):e70-e88. https://doi.org/10.1164/rccm.201908-1590ST
Zanconato S, Meneghelli G, Braga R, Zacchello F, Baraldi E. Office spirometry in primary care pediatrics: a pilot study. Pediatrics. 2005;116(6):e792-7. https://doi.org/10.1542/peds.2005-0487
Müller-Brandes C, Krämer U, Gappa M, Seitner-Sorge G, Hüls A, von Berg A, et al. LUNOKID: can numerical American Thoracic Society/European Respiratory Society quality criteria replace visual inspection of spirometry? Eur Respir J. 2014;43(5):1347-56. https://doi.org/10.1183/09031936.00058813
van der Kamp MR, Klaver EC, Thio BJ, Driessen JMM, de Jongh FHC, Tabak M, et al. WEARCON: wearable home monitoring in children with asthma reveals a strong association with hospital based assessment of asthma control. BMC Med Inform Decis Mak. 2020;20(1):192. https://doi.org/10.1186/s12911-020-01210-1
van Delden R, Plass Oude Bos D, de With V, Vogel K, Klaassen R, Zwart, N, et al. SpiroPlay, a Suite of Breathing Games for Spirometry by Kids & Experts. ACM Publishing. 2020. https://doi.org/10.1145/3410404.3414223
Arets HG, Brackel HJ, van der Ent CK. Forced expiratory manoeuvres in children: do they meet ATS and ERS criteria for spirometry? Eur Respir J. 2001;18(4):655-60. https://doi.org/10.1183/09031936.01.00204301
Hall GL, Thompson BR, Stanojevic S, Abramson MJ, Beasley R, Coates A, et al. The Global Lung Initiative 2012 reference values reflect contemporary Australasian spirometry. Respirology. 2012;17(7):1150–1151. https://doi.org/10.1111/j.1440-1843.2012.02232.x
Palamarchuk P. Elaboración de curvas de referencia normales de espirometría en niños uruguayos mediante modelos GAMLSS. [Tesis de grado]. Universidad de la República. Uruguay. 2017. https://hdl.handle.net/20.500.12008/26645
Quanjer PH, Hall GL, Stanojevic S, Cole T, Stocks J. Age-and height-based prediction bias in spirometry reference equations. Eur Respir J. 2012;40(1):190-197. https://doi.org/10.1183/09031936.00161011
Stanojevic S, Wade A, Stocks J, Hankinson J, Coates AL, Pan H, et al. Reference ranges for spirometry across all ages: a new approach. Am J Respir Crit Care Med. 2008;177(3):253-60. https://doi.org/10.1164/rccm.200708-1248OC
Nève V, Machuron F, Behal H, Howsam M, Methlin CM, Delille C, et al. Global Lung Initiative spirometry references in healthy 3-15-year-old French children. ERJ Open Res. 2019;5(3):00023-2019. https://doi.org/10.1183/23120541.00023-2019
Bonner R, Lum S, Stocks J, Kirkby J, Wade A, Sonnappa S. Applicability of the global lung function spirometry equations in contemporary multiethnic children. Am J Respir Crit Care Med. 2013;188(4):515–516. https://doi.org/10.1164/rccm.201212-2208LE
Arigliani M, Canciani MC, Mottini G, Altomare M, Magnolato A, Vanda Loa Clemente S. Evaluation of the Global Lung Initiative 2012 reference values for spirometry in African children. Am J Respir Crit Care Med. 2017;195(2):229–236. https://doi.org/10.1164/rccm.201604-0693OC
Chang SM, Tsai HJ, Tzeng JY, Kuo-Wei Yeh, Li-Chen Chen, Shen-Hao Lai, et al. Reference equations for spirometry in healthy Asian children aged 5 to 18 years in Taiwan. World Allergy Organ J. 2019;12(11):100074. https://doi.org/10.1016/j.waojou.2019.100074
Al-Qerem W. Spirometry reference equations for children from a Middle Eastern population. Int J ClinPract. 2021;75(10):e14598. https://doi.org/10.1111/ijcp.14598
Jones MH, Vidal PCV, Lanza FC, França de Melo Franco Silva DC, Pitrez PM, Bigliardi de Freitas Olmedo AP, et al. Reference values for spirometry in Brazilian children. J Bras Pneumol. 2020;46(3):e20190138. https://doi.org/10.36416/1806-3756/e20190138
Ben Salah N, Bejar D, Snène H, Ouahchi Y, Mehiri N, Louzir B. The Z-score: A new tool in the interpretation of spirometric data. Tunis Med. 2017;95(8-9):767-771. https://latunisiemedicale.com/index.php/tunismed/article/view/3289
.png)
Todo el contenido de esta revista, está bajo 