Spirometry and paediatric pulmonary-function testing — structured clinical encounter

Structured encounter interpreting spirometry in an 11-year-old with cough and wheeze: judging the quality of the test, recognising the obstructive pattern and its bronchodilator response, using GLI z-scores rather than fixed cut-offs, explaining why the normal baseline value does not exclude asthma, and integrating the result with the clinical picture.

structured clinical encounter3 min readVerification in progress

Prompt

An 11-year-old boy is referred with a year of cough and intermittent wheeze, worse at night and with running. You are the paediatric registrar asked to interpret his spirometry, decide what it does and does not tell you about asthma, plan any further lung-function testing, and explain the result to him and his mother.

Station brief (candidate)

You are the paediatric registrar in a respiratory clinic. An 11-year-old boy has a year of cough and intermittent wheeze, worse at night and on running, and normal growth. His spirometry report and flow-volume loop are in front of you. The team asks you to judge whether the test is trustworthy, interpret the pattern, decide what further lung-function testing is warranted, and explain the findings to the boy and his mother. You have 12 minutes with the family and 5 minutes for examiner discussion. ^[10]

References5Show

[1]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.PMID 31613151
[2]Stanojevic S; Kaminsky DA; Miller MR; Thompson B; Aliverti A; Barjaktarevic I; et al ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J, 2022.PMID 34949706
[3]Quanjer PH; Stanojevic S; 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.PMID 22743675
[10]Gaillard EA; Kuehni CE; Turner S; Goutaki M; Holden KA; de Jong CCM; et al European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years. Eur Respir J, 2021.PMID 33863747
[12]Levy ML; Bacharier LB; Bateman E; Boulet LP; Brightling C; Buhl R; et al Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med, 2023.PMID 36754956

Spirometry and paediatric pulmonary-function testing — structured clinical encounter

structured clinical encounter3 min readVerification in progress

Station brief (candidate)

References5Show

[1]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.PMID 31613151
[2]Stanojevic S; Kaminsky DA; Miller MR; Thompson B; Aliverti A; Barjaktarevic I; et al ERS/ATS technical standard on interpretive strategies for routine lung function tests. Eur Respir J, 2022.PMID 34949706
[3]Quanjer PH; Stanojevic S; 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.PMID 22743675
[10]Gaillard EA; Kuehni CE; Turner S; Goutaki M; Holden KA; de Jong CCM; et al European Respiratory Society clinical practice guidelines for the diagnosis of asthma in children aged 5-16 years. Eur Respir J, 2021.PMID 33863747
[12]Levy ML; Bacharier LB; Bateman E; Boulet LP; Brightling C; Buhl R; et al Key recommendations for primary care from the 2022 Global Initiative for Asthma (GINA) update. NPJ Prim Care Respir Med, 2023.PMID 36754956