The EPICure study: Comparison of pediatric spirometry in community and laboratory settings

Rationale Accuracy of spirometry testing is a prerequisite for its use as an objective outcome measure in large epidemiological studies. We compared spirometry measurements obtained by trained pediatricians in a variety of school settings with those obtained in the laboratory by respiratory physiologists. Methods Following a 3‐day training course, three pediatricians carried out spirometry in children born extremely preterm (EP) and age matched controls in schools across the UK and Ireland (The EPICure study). A subgroup had repeated measurements in the laboratory. Spirometric flows and volumes were expressed as Z‐scores. Bland–Altman analysis was used to calculate within‐subject differences. Results Fifty children (40% boys), 37 (74%) of whom were born EP, with a mean age 10.8 years had paired spirometry results (average interval between tests: 20.3 weeks). There was no statistically significant difference between any of the outcome variables: mean (95% CI of difference) in Z‐scores [school–laboratory]) being 0.0 (−0.1; 0.1) for FEV 1 , 0.1 (−0.1; 0.3) for FVC, −0.1 (−0.3; 0.1) for FEF 25–75 , and 0.0 (−0.3; 0.1) for FEV 1 /FVC. Within individuals, the 95% limits of agreement for repeated measures were within ± 1 Z‐score for FEV 1 and FVC, and within ± 1.5 Z‐score for FEF 25–75 and FEV 1 /FVC. Conclusion With appropriate training, quality control, and support, pediatric spirometry can reliably be performed outside the lung function laboratory. Pediatr. Pulmonol. 2008; 43:1233–1241. © 2008 Wiley‐Liss, Inc.