RT info:eu-repo/semantics/doctoralThesis
T1 Oscilometría y espirometría en asma infantil: factibilidad en la práctica clínica
A1 Domínguez Martín, Clara
A2 Universidad de Valladolid. Escuela de Doctorado
K1 Pediatría
K1 Asthma
K1 Asma
K1 Child
K1 Niños
K1 Spirometry
K1 Espirometría
K1 Oscillometry
K1 Oscilometría
K1 32 Ciencias Médicas
AB Objectives: 1. To evaluate the feasibility of respiratory oscillometry (RO), fractional exhaled nitric oxide (FeNO) and spirometry in schoolchildren with asthma. 2. To measure the agreement of the results of RO and spirometry in asthmatic schoolchildren. 3. To assess the clinical usefulness of RO and spirometry in asthmatic schoolchildren to predict the probability of appearance of severe asthma exacerbations (SAE) in the medium term.Methods: In a descriptive, cross-sectional and prospective study, 154 children (6-14 years) with diagnosed asthma performed RO, FeNO, spirometry and bronchodilator testing (BDT). First, we made both a clinical-epidemiological questionnaire and lung function testing and later, on a second row 12 weeks later, we repeated the procedure to record the clinical evolution between both times and correlate the results.The feasibility of performing RO and spirometry with the McNemar test were analyzed. Factors that could affect the feasibility of performing RO and spirometry were investigated using multiple, linear or logistic regression models, depending on each case.The concordance of RO and spirometry results were analyzed in two ways: intraclass correlation coefficients (ICC) and kappa indices.The clinical performance of RO and spirometry were compared in terms of their ability to predict: the probability of suffering an episode of SAE, unscheduled visits to Primary Health Care or the Emergency Health Department, and asthma control. Data was analyzed using the Mann-Whitney test. ROC curves were constructed and the area under the curve (AUC) and its 95% confidence interval were calculated. For lung function variables with significant AUC we measured sensitivity, specificity, positive (LR+) and negative (LR-) likelihood ratios.Results: There were no differences in the probability of obtaining a valid RO or spirometry (83.1% vs. 81.8%, p=0.868). RO required a lower number of maneuvers [mean (standard deviation) 4.8 (2.1) vs 6.3 (1.6), p<0.001] and less execution time [5.9 (3.1) vs 8.2 (2.6) minutes, p<0.001], and was considered less difficult by patients to achieve. The age increased the probability of obtaining valid RO and spirometry.The agreement of the results between RO and spirometry was low, and only between zFEV1 and zAX could be considered a moderate correlation (ICC=0.412, kappa=0.427). 7.5% had an episode of SAE at follow-up. The best AUC was registered with forced expiratory flow 25-75%: 0.787, 95% confidence interval 0.600-0.973. Reactance area (AX), forced expiratory volume in first second (FEV1), post- BDT change in forced vital capacity (FVC), and FEV1/FVC ratio also had significant AUC. All variables had low sensitivity for predicting episodes of SAE, especially those with the highest specificity (post- BDT change in FVC). Only zFEF25-75 had both significant LR+ and LR-.Conclusions: RO, FeNO, and spirometry are feasible in ashtmatic schoolchildren; also they spend less time and fewer maneuvers to achieve a RO than a valid spirometry. In addition, they consider RO to be easier to perform than spirometry. Age increases the probability of obtaining a valid RO and spirometry. In addition, the time needed to achieve a RO maneuver decreases. The perception of the difficulty of spirometry increases with aging. Previous experiences with spirometry performed, showed that they decreases the time needed to achieve a valid test and the number of maneuvers. The concordance registered of results between RO and spirometry is low-moderate. The values with the highest concordance are zAX and zFEV1.Spirometry performed better than RO for predicting mid-term SAE episodes, attendance at unscheduled medical appointments and poor asthma control in schoolchildren with the diagnosis of asthma.
YR 2025
FD 2025
LK https://uvadoc.uva.es/handle/10324/76276
UL https://uvadoc.uva.es/handle/10324/76276
LA spa
NO Escuela de Doctorado
DS UVaDOC
RD 12-jul-2025